Physiological skin manifestations in twins: association with maternal and neonatal factors.
[lamellar ichthyosis]
There is paucity of literature on the incidence and clinical associations of transient benign dermatological conditions in twin neonates. This prospective study evaluated 253 live-born twin babies (≥23 wks) at a tertiary care hospital in Delhi, India. All study subjects were observed for the first 7 days of life, and regular dermatological examination was performed. The primary focus was on palatine Epstein pearls (PEP), milia, erythema toxicum neonatorum (ETN), and physiological skin desquamation (PDS). Zygosity was determined with the help of sex combination of the pairs, chorionicity of the placentae, and seven blood group phenotypes. Chi-square test, Cohen's kappa test, and logistic regression analysis were done. PEP, milia, ETN, and PDS were seen in 88.1%, 83.4%, 2.4%, and 4.3% twin babies, respectively. Preputial Epstein pearls were not seen. Birth order, maternal anemia, route of delivery, meconium staining of amniotic fluid, gestational maturity, birth weight, and presence of intrauterine growth restriction were found to be associated with one or more of the studied skin conditions (p < 0.05), but maternal age, pregnancy-induced hypertension, and sex of the baby did not affect incidence of any (p > 0.05). The intrapair concordance was highly significant (p < 0.001) in mono- and dizygotic twins. PEP and milia were equally common in the evaluated twins as compared to reports in singletons, while ETN and PDS were less common in this twin cohort. Environmental and genetic factors may regulate physiological skin manifestations in newborns.
