occlusive ointment. Topical keratolytics and retinoids are rarely used. Acitretin given at 0.1-0.75 mg/kg/day intermittently (three months on and off) reduces scaling, pruritus and erythema in most patients. Parents should be advised to attend genetic counseling.
Learning points: The possible outcomes of collodion baby include normal skin (self-healing collodion baby), non- bullous ichthyosiform erythroderma, lamellar ichthyosis and rare disorders. In those without a family history, diagnosis is guided by assessment over regular intervals and skin biopsy.
Griffiths WA, Leigh IM, Mark R. Disorders of keratinisation: Congenital ichthyosis. In: Champion RH, Burton JL, Ebling FJ ed. Textbook of Dermatology. Blackwell Scientific Publication, 1998;35:1493-8.
Goldsmith LA. N-alkanes in the skin. Arch Dermatol 1990; 126:868-70.
Frenk E. A spontaneously healing collodion baby: a light and electron microscopical study. Acta Derm Venreol 1998;61:168-
Larregue M, Gharbi R, Daniel J, et al. Collodion baby. Clinical course based on 29 cases. Ann Dermatol Syphiligr (Paris) 1976; 103:31-56.
Frenk E, Techtermann F. Self-healing collodion baby: evidence for autosomal recessive inheritance. Pediatr Dermatol 1992;9: 95-7.
Answers to Dermato-venereological Quiz on page 149
Answer (Question 1)
The pictures show two marginated erythematous papules, with slight scaling. Together with the history, the most likely diagnosis is superficial basal cell carcinoma. The differential diagnoses include actinic keratoses, Bowen's disease and possibly psoriasis.
Histologically superficial basal cell carcinomas show buds of basaloid cells originating from the lower margin of the epidermis and extending down into the papillary dermis. The individual cells have large oval basophilic nuclei and minimal cytoplasm, resembling the basal cells of the epidemis. Peripheral palisading is present. These buds are actually interconnected and the lateral margin of the lesion is often difficult to define.
3. Generally the first line treatments include curettage and electrodesiccation, cryosurgery, excision and Mohs micrographic surgery. Surgical excision has the advantage of allowing histological examination and Mohs surgery is generally reserved for high risk tumours. Other options include radiotherapy and more experimental ones like intralesional interferon, topical imiquimod and photodynamic therapy. Regardless of the therapy chosen, more importantly, the patient should be followed up for the possibility of local recurrence and another basal cell carcinoma elsewhere.
Answer (Question 2)
The main differential diagnoses include erythroplasia of Queyrat and plasma cell balanitis. Other possibilities include extramammary Paget's disease, erosive lichen planus etc.
This patient had erythroplasia of Queyrat as confirmed by skin biopsy. Erythroplasia of Queyrat shows the histological features of intraepidermal squamous cell carcinoma.
3. Treatment should be individualized for patients with erythroplasia of Queyrat. Definitive treatment may be achieved with surgical excision or Mohs micrographic surgery. Other options include topical 5- flourouracil, carbon dioxide laser and possibly photodynamic therapy.
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