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the membrane had fallen completely by the second week of life&#46; The clinical course was very good over the following months&#44; and at 1 year the skin had a practically normal appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#44; showing only mild erythema and peeling on both cheeks &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and minimal hyperkeratosis on the elbows and knees&#46; A diagnosis of self-healing collodion baby &#40;CB&#41; was made&#46; Genetic analysis showed the child to be a homozygous carrier of a mutation in the <span class="elsevierStyleItalic">ALOX12B</span> gene that produced loss of an amino acid&#44; glutamine&#44; at position 136 of exon 3&#59; the parents were healthy heterozygous carriers of this mutation&#46; At the time of writing this article&#44; the patient was 2 years of age and had no lesions except those commented above&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">CB presents at birth with a tight&#44; shiny&#44; transparent&#44; armor-like membrane that covers the whole body surface and looks like cellophane wrapping&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> This can give rise to ectropion&#44; eclabium&#44; pseudocontractures&#44; absence of eyebrows&#44; sparse hair&#44; and hypoplasia of the nasal and auricular cartilage&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The membrane is inelastic&#44; so the child&#39;s breathing and movements after birth provoke fissuring&#44; and it then peels away in large sheets and is completely lost by 2 to 4 weeks of life&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> CB is a rare condition&#44; with an incidence between 1 in 50<span class="elsevierStyleHsp" style=""></span>000 to 1 in 100<span class="elsevierStyleHsp" style=""></span>000 births&#46; It is the initial clinical manifestation of a number of genetic diseases&#44; the majority of which belong to the group of autosomal recessive congenital ichthyoses &#40;ARCI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> CB can develop into very diverse phenotypes&#44; from skin with a normal appearance to intense ichthyosis&#59; the majority of patients are diagnosed with lamellar ichthyosis or congenital ichthyosiform erythroderma&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a> Self-resolving CB is a minor form of ARCI&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Between 10&#37; and 24&#37; of cases of CB are self-resolving&#59; these are cases that show spontaneous resolution of the condition and in adult life present a normal skin or discreet signs of ichthyosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5</span></a> Regarding the epidemiology of ARCI&#44; Hern&#225;ndez-Mart&#237;n et al&#46;&#44; in Spain&#44; published a study in which the estimated prevalence of ARCI was of approximately 16 cases per million population&#44; with a prevalence of self-resolving CB of 4&#46;2&#37; in the overall ARCI population&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Self-resolving CB has been associated with mutations in genes <span class="elsevierStyleItalic">TGM1</span>&#44; <span class="elsevierStyleItalic">ALOXE3</span>&#44; and <span class="elsevierStyleItalic">ALOX12B</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#8211;5&#44;7</span></a> Our patient was diagnosed as a homozygous carrier of a mutation in gene <span class="elsevierStyleItalic">ALOX12B</span> that has not previously been described in the literature&#46; The <span class="elsevierStyleItalic">ALOX12B</span> gene was first identified in 2002&#46; It is formed of 15 exons and codes for the epidermal lipoxygenases eLOX-3 and 12R-LOX&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Its predominant expression in the suprabasal layers of the epidermis supports its role in the advanced phases of epidermal differentiation and its participation in processing lamellar bodies&#46; In addition&#44; it acts in the hepoxilin pathway and is therefore thought possibly to participate in the formation of the intercellular lipids of the corneal layer or to act in signaling to promote keratinocyte differentiation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">More than 30 mutations of the <span class="elsevierStyleItalic">ALOX12B</span> gene have been described since its identification and&#44; together with gene <span class="elsevierStyleItalic">ALOXE3</span>&#44; it is considered responsible for 14&#37; to 17&#37; of ARCIs and for 72&#46;2&#37; of cases of self-resolving CB&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The specific mechanism that leads to the changes in skin permeability in patients with alterations of gene <span class="elsevierStyleItalic">ALOX12B</span>&#44; and the reason for the appearance of lesions in the neonatal period in self-resolving CB&#44; are not fully understood&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It has been postulated that these mutations of <span class="elsevierStyleItalic">ALOX12B</span> reduce enzyme activity in utero&#44; but not after birth&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Hydrostatic pressure is high in the uterus&#44; and the chelation of water molecules deforms the mutated enzyme into an inactive conformation&#46; After birth&#44; with a lower hydrostatic pressure&#44; the enzyme returns to its active form and increases its activity to levels sufficient to maintain a normal or minimally altered phenotype&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">CB usually causes premature delivery&#44; with increased perinatal morbidity and mortality&#46; Important complications include increased transepidermal water loss &#40;up to 7 times the loss from healthy skin&#41;&#44; temperature instability&#44; hypothermia&#44; hypernatremic dehydration&#44; feeding difficulties&#44; hypohidrosis&#44; cutaneous and systemic infections&#44; ectropion&#44; keratitis&#44; and obstruction of the external auditory meatus&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;10</span></a> Furthermore&#44; the membrane can produce mechanical compression that may lead to distal limb ischemia&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The management of CB must be undertaken in a neonatal intensive care unit&#46; Humidity in the incubator should be at least 60&#37;&#44; with temperature control&#44; monitoring of electrolytes&#44; energy supplementation&#44; and insertion of a nasogastric tube if feeding is compromised&#46; Although prophylactic antibiotics are not recommended&#44; very close monitoring must be performed and antibiotic therapy initiated early if signs of infection develop&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The use of emollients reduces transepidermal water loss and its related complications&#44; though health staff must perform adequate hand washing and hygiene prior to applying the agents in order to reduce the risk of infection&#44; as this has been related to the application of emollients in some reports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Mortality in CB is currently around 5&#37;&#59; in 1960 it was estimated to be around 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;10</span></a> It is believed that the marked improvement in prognosis is due to the advances in neonatal care&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Reporting this new case of CB is important because of its progression to self-resolving CB&#44; a very rare entity&#46; Self-resolving CB is a challenge not because of diagnostic problems&#44; but rather because of the difficulty in establishing a long-term prognosis&#44; as it is impossible to say whether a case will be a true self-resolving CB or whether it will&#44; in contrast&#44; develop into a very severe disease&#46; Furthermore&#44; the genetic analysis performed on our patient detected a mutation in the <span class="elsevierStyleItalic">ALOX12B</span> gene that had not previously been described in the literature as a mutation confirmed to cause self-resolving CB&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Self-healing Collodion Baby: A New Mutation in the ALOX12B Gene
Bebé colodión autorresolutivo: nueva mutación en el gen ALOX12B
R. Santesteban Muruzábala,
Autor para correspondencia
raquel.santesteban@hotmail.com

Corresponding author.
, A. Larumbe Irurzuna, I. Yanguas Bayonaa, M.A. Ramos Arroyob
a Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Spain
b Servicio de Genética, Complejo Hospitalario de Navarra, Pamplona, Spain
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the membrane had fallen completely by the second week of life&#46; The clinical course was very good over the following months&#44; and at 1 year the skin had a practically normal appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#44; showing only mild erythema and peeling on both cheeks &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and minimal hyperkeratosis on the elbows and knees&#46; A diagnosis of self-healing collodion baby &#40;CB&#41; was made&#46; Genetic analysis showed the child to be a homozygous carrier of a mutation in the <span class="elsevierStyleItalic">ALOX12B</span> gene that produced loss of an amino acid&#44; glutamine&#44; at position 136 of exon 3&#59; the parents were healthy heterozygous carriers of this mutation&#46; At the time of writing this article&#44; the patient was 2 years of age and had no lesions except those commented above&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">CB presents at birth with a tight&#44; shiny&#44; transparent&#44; armor-like membrane that covers the whole body surface and looks like cellophane wrapping&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> This can give rise to ectropion&#44; eclabium&#44; pseudocontractures&#44; absence of eyebrows&#44; sparse hair&#44; and hypoplasia of the nasal and auricular cartilage&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The membrane is inelastic&#44; so the child&#39;s breathing and movements after birth provoke fissuring&#44; and it then peels away in large sheets and is completely lost by 2 to 4 weeks of life&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> CB is a rare condition&#44; with an incidence between 1 in 50<span class="elsevierStyleHsp" style=""></span>000 to 1 in 100<span class="elsevierStyleHsp" style=""></span>000 births&#46; It is the initial clinical manifestation of a number of genetic diseases&#44; 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Hern&#225;ndez-Mart&#237;n et al&#46;&#44; in Spain&#44; published a study in which the estimated prevalence of ARCI was of approximately 16 cases per million population&#44; with a prevalence of self-resolving CB of 4&#46;2&#37; in the overall ARCI population&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Self-resolving CB has been associated with mutations in genes <span class="elsevierStyleItalic">TGM1</span>&#44; <span class="elsevierStyleItalic">ALOXE3</span>&#44; and <span class="elsevierStyleItalic">ALOX12B</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#8211;5&#44;7</span></a> Our patient was diagnosed as a homozygous carrier of a mutation in gene <span class="elsevierStyleItalic">ALOX12B</span> that has not previously been described in the literature&#46; The <span class="elsevierStyleItalic">ALOX12B</span> gene was first identified in 2002&#46; It is formed of 15 exons and codes for the epidermal lipoxygenases eLOX-3 and 12R-LOX&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Its predominant expression in the suprabasal layers of the epidermis supports its role in the advanced phases of epidermal differentiation and its participation in processing lamellar bodies&#46; In addition&#44; it acts in the hepoxilin pathway and is therefore thought possibly to participate in the formation of the intercellular lipids of the corneal layer or to act in signaling to promote keratinocyte differentiation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">More than 30 mutations of the <span class="elsevierStyleItalic">ALOX12B</span> gene have been described since its identification and&#44; together with gene <span class="elsevierStyleItalic">ALOXE3</span>&#44; it is considered responsible for 14&#37; to 17&#37; of ARCIs and for 72&#46;2&#37; of cases of self-resolving CB&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The specific mechanism that leads to the changes in skin permeability in patients with alterations of gene <span class="elsevierStyleItalic">ALOX12B</span>&#44; and the reason for the appearance of lesions in the neonatal period in self-resolving CB&#44; are not fully understood&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It has been postulated that these mutations of <span class="elsevierStyleItalic">ALOX12B</span> reduce enzyme activity in utero&#44; but not after birth&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Hydrostatic pressure is high in the uterus&#44; and the chelation of water molecules deforms the mutated enzyme into an inactive conformation&#46; After birth&#44; with a lower hydrostatic pressure&#44; the enzyme returns to its active form and increases its activity to levels sufficient to maintain a normal or minimally altered phenotype&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">CB usually causes premature delivery&#44; with increased perinatal morbidity and mortality&#46; Important complications include increased transepidermal water loss &#40;up to 7 times the loss from healthy skin&#41;&#44; temperature instability&#44; hypothermia&#44; hypernatremic dehydration&#44; feeding difficulties&#44; hypohidrosis&#44; cutaneous and systemic infections&#44; ectropion&#44; keratitis&#44; and obstruction of the external auditory meatus&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;5&#44;10</span></a> Furthermore&#44; the membrane can produce mechanical compression that may lead to distal limb ischemia&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The management of CB must be undertaken in a neonatal intensive care unit&#46; Humidity in the incubator should be at least 60&#37;&#44; with temperature control&#44; monitoring of electrolytes&#44; energy supplementation&#44; and insertion of a nasogastric tube if feeding is compromised&#46; Although prophylactic antibiotics are not recommended&#44; very close monitoring must be performed and antibiotic therapy initiated early if signs of infection develop&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The use of emollients reduces transepidermal water loss and its related complications&#44; though health staff must perform adequate hand washing and hygiene prior to applying the agents in order to reduce the risk of infection&#44; as this has been related to the application of emollients in some reports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Mortality in CB is currently around 5&#37;&#59; in 1960 it was estimated to be around 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;10</span></a> It is believed that the marked improvement in prognosis is due to the advances in neonatal care&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Reporting this new case of CB is important because of its progression to self-resolving CB&#44; a very rare entity&#46; Self-resolving CB is a challenge not because of diagnostic problems&#44; but rather because of the difficulty in establishing a long-term prognosis&#44; as it is impossible to say whether a case will be a true self-resolving CB or whether it will&#44; in contrast&#44; develop into a very severe disease&#46; Furthermore&#44; the genetic analysis performed on our patient detected a mutation in the <span class="elsevierStyleItalic">ALOX12B</span> gene that had not previously been described in the literature as a mutation confirmed to cause self-resolving CB&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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ISSN: 15782190
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2021 Noviembre 74 45 119
2021 Octubre 96 50 146
2021 Septiembre 69 45 114
2021 Agosto 66 33 99
2021 Julio 57 38 95
2021 Junio 67 23 90
2021 Mayo 119 38 157
2021 Abril 132 97 229
2021 Marzo 83 36 119
2021 Febrero 87 24 111
2021 Enero 51 16 67
2020 Diciembre 66 18 84
2020 Noviembre 48 27 75
2020 Octubre 69 18 87
2020 Septiembre 38 17 55
2020 Agosto 33 15 48
2020 Julio 33 14 47
2020 Junio 32 37 69
2020 Mayo 52 20 72
2020 Abril 25 20 45
2020 Marzo 13 19 32
2020 Febrero 9 1 10
2019 Diciembre 4 0 4
2019 Septiembre 4 0 4
2019 Junio 2 0 2
2019 Abril 0 1 1
2019 Marzo 2 3 5
2019 Enero 2 0 2
2018 Diciembre 3 0 3
2018 Octubre 3 0 3
2018 Septiembre 4 0 4
2018 Febrero 30 4 34
2018 Enero 45 4 49
2017 Diciembre 60 7 67
2017 Noviembre 47 6 53
2017 Octubre 54 10 64
2017 Septiembre 48 11 59
2017 Agosto 34 3 37
2017 Julio 37 6 43
2017 Junio 48 9 57
2017 Mayo 28 11 39
2017 Abril 30 6 36
2017 Marzo 27 5 32
2017 Febrero 63 9 72
2017 Enero 23 6 29
2016 Diciembre 41 27 68
2016 Noviembre 26 33 59
2016 Octubre 26 25 51
2016 Julio 1 6 7
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