Harlequin color change

Harlequin color change is a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body's midline. This transient change occurs in approximately 10% of healthy newborns.[1] It is seen usually between two and five days of birth. The condition lasts from 30 seconds to 20 minutes and then fades. It may recur when the infant is placed on his or her side, as the intensity of color has been shown to be gravity dependent and considerably variable from one infant to another.[2]

The dark red color skin of the newborn with harlequin signs indicates polycythemia. Polycythemia is common in preterm infants because of the presence of fetal red blood cells (RBCs).[3] The condition is also often seen in healthy newborns although associations like with prematurity, low birth weight, hypoxia, systemic use of prostaglandin E1, or intracranial injury, meningitis and even anesthesia has been mentioned in the literature.[4][5][6][7][8][9] Probable differential diagnosis are Port-wine stain and nascent hemangioma of infancy, but these can be differentiated due to transient nature of this condition.[1]

Hypothesized pathogenesis involves temporary imbalance in the tone of cutaneous blood vessels secondary to hypothalamic immaturity.[10]

This condition was first described by Neligan and Strang in 1952 and was named so.[5]


  1. ^ a b Cordoro, Kelly M.; Speetzen, Larisa S.; Koerper, Marion A.; Frieden, Ilona J. "Physiologic changes in vascular birthmarks during early infancy: Mechanisms and clinical implications". Journal of the American Academy of Dermatology. 60 (4): 669–675. doi:10.1016/j.jaad.2008.11.020.
  2. ^ M.A. Selimoglu et al., "PICTURE OF THE MONTH - HARLEQUIN COLOR-CHANGE", Archives of Pediatrics & Adolescent Medicine, 149(10), 1995, pp. 1171-1172
  3. ^ {Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (n.d.). Maternal child nursing care.}
  4. ^ Velayuthan, S.; Sankararaman, S. (1 July 2013). "Visual Diagnosis: Newborn Who Has Unilateral Color Change". Pediatrics in Review. 34 (7): e25–e26. doi:10.1542/pir.34-7-e25.
  5. ^ a b Neligan GA, Strang LB (1952). "A "harlequin" colour change in the newborn". Lancet. 263: 1005–1007. doi:10.1016/s0140-6736(52)91182-3.
  6. ^ Rao, Jaggi; Campbell, Morag E.; Krol, Alfons (1 September 2004). "The Harlequin Color Change and Association with Prostaglandin E1". Pediatric Dermatology. 21 (5): 573–576. doi:10.1111/j.0736-8046.2004.21511.x.
  7. ^ Wagner, DL; Sewell, AD (May 1985). "Harlequin color change in an infant during anesthesia" (PDF). Anesthesiology. 62 (5): 695. doi:10.1097/00000542-198505000-00039. PMID 4039544.
  8. ^ Lee, RS; Wan, HS; Chan, RL (December 2012). "Harlequin colour change in a newborn with meningitis". Hong Kong medical journal. 18 (6): 539.e3-4. PMID 23223664.
  9. ^ Rao, Jaggi; Krol, Alfons (4 September 2003). "The Harlequin Color Change". New England Journal of Medicine. 349 (10): 968–968. doi:10.1056/NEJMicm020831.
  10. ^ PADDA, GURPREET S.; CRUZ, OSCAR A.; SILEN, MARK L.; KROCK, JEREMY L. (1 March 1999). "Skin conductance responses in paediatric Harlequin syndrome". Pediatric Anesthesia. 9 (2): 159–162. doi:10.1046/j.1460-9592.1999.9220266.x.

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