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Case Reports
. 2015 Apr;5(1):e73-6.
doi: 10.1055/s-0035-1545671. Epub 2015 Mar 2.

Harlequin Color Change: Neonatal Case Series and Brief Literature Review

Enrico Valerio  1 , Alessia Barlotta  1 , Eleonora Lorenzon  1 , Livio Antonazzo  1 , Mario Cutrone  2
Affiliations
Case Reports

Harlequin Color Change: Neonatal Case Series and Brief Literature Review

Enrico Valerio et al. AJP Rep. 2015 Apr.

Abstract

First clinical report of Harlequin color change (HCC) phenomenon came in 1952 from Neligan and Strang. Since then, HCC has been described in a fairly broad number of clinical reports involving neonates, infants, children, and adult patients. We here present a small case series of HCC occurring in neonates, pointing out three of the different possible presentations (hemifacial, patchy scattered across the whole body, and hemiscrotal) of this phenomenon. A brief discussion and literature review encompassing epidemiology, clinical features, physiopathology, associated conditions, and differential diagnoses of HCC is then presented. In most cases, HCC represents a benign, idiopathic, and rapidly autoresolutive phenomenon, with no need for treatment. Some drugs (especially anesthetics and prostaglandin E) are thought to enhance HCC expression through their influence on the capillary tone in the peripheral vascular bed; this effect is anyway promptly reversible with drug withdrawal. Only in rare circumstances, HCC may act as a clue for serious central nervous system disorders (e.g., meningitis; hypothalamic, brain stem, or sympathetic nervous system lesions); anyway, in these rare occurrences HCC always represents an epiphenomenon of the disease, never acting as the sole sign of the underlying disorder.

Keywords: dermatology; harlequin color change; infant; neonate; preterm.

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Conflict of interest statement

Conflicts of Interest None.

Figures

Fig. 1
Fig. 1
Facial harlequin color change in a late preterm White newborn administered IV antibiotic therapy for a vaginal delivery with history of premature rupture of membranes; the baby was on his right side when the rash began. Overall phenomenon lasted 2 minutes and then rapidly vanished.
Fig. 2
Fig. 2
Harlequin phenomenon in a Moroccan preterm newborn (31 weeks' gestational age). Regional, clear-cut edge skin discoloration started 10 minutes after delivery during intense crying, involving face and right hemibody of the neonate, and vanished minutes after.
Fig. 3
Fig. 3
Harlequin color change of the right hemiscrotum in a term Caucasian neonate after bath. The baby was otherwise asymptomatic. No other skin district was interested. Phenomenon quickly regressed in 1 minute, leaving scrotum evenly pink.
See this image and copyright information in PMC

References

    1. Neligan G A, Strang L B. A “harlequin” colour change in the newborn. Lancet. 1952;2(6743):1005–1007. - PubMed
    1. Lucky A W. Philadelphia, PA: Saunders Elsevier; 2008. Transient benign cutaneous lesions in the newborn; pp. 85–97.
    1. Morelli J G. Philadelphia, PA: Saunders Elsevier; 2007. Diseases of the neonate; pp. 2661–2664.
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    1. Lee R S, Wan H S, Chan R L. Harlequin colour change in a newborn with meningitis. Hong Kong Med J. 2012;18(6):539000–5.39E6. - PubMed

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