HARLEQUIN ICHTHYOSIS
What Is Harlequin Ichthyosis?
Harlequin ichthyosis is a severe genetic disorder that mainly affects the
skin. Infants with this condition are born with very hard, thick skin covering
most of their bodies. The skin forms large diamond-shaped plates separated by
deep cracks (fissures). These skin abnormalities affect the shape of the
eyelids, nose, mouth and ears, and restrict movement of the arms and legs.
Restricted movement of the chest can lead to breathing difficulties and
respiratory failure.
The skin normally forms a protective barrier between the body and its
surrounding environment. The skin abnormalities associated with harlequin
ichthyosis disrupt this barrier, making it more difficult for affected infants
to control water loss, regulate their body temperature and fight infections.
Infants with harlequin ichthyosis often experience an excessive loss of fluids
from the body (dehydration) and develop life-threatening infections during the
newborn period.
How Common Is Harlequin Ichthyosis?
Harlequin ichthyosis is very rare; its exact incidence is unknown.
What Genes Are Related to Harlequin Ichthyosis?
Mutations in the ABCA12 gene cause harlequin ichthyosis.
The ABCA12 gene makes a protein that is essential for the normal development
of skin cells. This protein appears to play a major role in the transport of
lipids (fats) in the outermost layer of skin (the epidermis). Some mutations in
the ABCA12 gene prevent the cell from making any ABCA12 protein. Other mutations
lead to the production of an abnormally small version of the protein that cannot
transport lipids properly. The loss of functional ABCA12 protein disrupts the
normal development of the epidermis, preventing the skin from forming an
effective barrier and resulting in the hard, thick scales characteristic of
harlequin ichthyosis.
How Do People Inherit Harlequin Ichthyosis?
This condition is likely inherited in an autosomal recessive pattern, which
means two copies of the gene in each cell are altered. Most often, the parents
of an individual with an autosomal recessive disorder are carriers of one copy
of the altered gene but do not show signs and symptoms of the disorder.
What Other Names Do People Use for Harlequin Ichthyosis?
· Harlequin baby syndrome
· HI
· Ichthyosis Congenita, Harlequin Fetus
Type
References
1. Akiyama M, Sakai K, Sugiyama-Nakagiri Y, Yamanaka Y, McMillan JR, Sawamura
D, Niizeki H, Miyagawa S, Shimizu H. Compound Heterozygous Mutations Including a
De Novo Missense Mutation in ABCA12 Led to a Case of Harlequin Ichthyosis with
Moderate Clinical Severity. J Invest Dermatol. 2006 Jul;126(7):1518-23.
Epub 2006 May 4.
2. Akiyama M, Sugiyama-Nakagiri Y, Sakai K, McMillan JR, Goto M, Arita K,
Tsuji-Abe Y, Tabata N, Matsuoka K, Sasaki R, Sawamura D, Shimizu H. Mutations in
lipid transporter ABCA12 in harlequin ichthyosis and functional recovery by
corrective gene transfer. J Clin Invest. 2005 Jul;115(7):1777-84.
3. Akiyama M. The pathogenesis of severe congenital ichthyosis of the
neonate. J Dermatol Sci. 1999 Sep;21(2):96-104. Review.
4. Gene Review: Autosomal Recessive Congenital Ichthyosis
5. Hovnanian A. Harlequin ichthyosis unmasked: a defect of lipid transport.
J Clin Invest. 2005 Jul;115(7):1708-10. Review.
6. Kelsell DP, Norgett EE, Unsworth H, Teh MT, Cullup T, Mein CA,
Dopping-Hepenstal PJ, Dale BA, Tadini G, Fleckman P, Stephens KG, Sybert VP,
Mallory SB, North BV, Witt DR, Sprecher E, Taylor AE, Ilchyshyn A, Kennedy CT,
Goodyear H, Moss C, Paige D, Harper JI, Young BD, Leigh IM, Eady RA, O'Toole EA.
Mutations in ABCA12 underlie the severe congenital skin disease harlequin
ichthyosis. Am J Hum Genet. 2005 May;76(5):794-803. Epub 2005 Mar 8.
7. Moskowitz DG, Fowler AJ, Heyman MB, Cohen SP, Crumrine D, Elias PM,
Williams ML. Pathophysiologic basis for growth failure in children with
ichthyosis: an evaluation of cutaneous ultrastructure, epidermal permeability
barrier function, and energy expenditure. J Pediatr. 2004
Jul;145(1):82-92.
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