The harlequin color change and association with prostaglandin E1

Pediatr Dermatol. 2004 Sep-Oct;21(5):573-6. doi: 10.1111/j.0736-8046.2004.21511.x.


The harlequin color change is an unusual cutaneous phenomenon observed in newborn infants as transient, benign episodes of a sharply demarcated erythema on half of the infant, with simultaneous contralateral blanching. In this report, two newborns with congenital heart anomalies demonstrated the harlequin color change, one whose skin findings showed a course related to the dose of systemic prostaglandin E1, suggesting a possible association. The benign, self-limited nature of the color change mandates that prostaglandin E1 not be discontinued for this reason. The entity is likely more common than the paucity of reports in the world literature suggests, and all physicians should recognize its graphic appearance to avoid unnecessary exposure to agents in an effort to treat it.

Publication types

  • Case Reports

MeSH terms

  • Alprostadil / administration & dosage
  • Alprostadil / adverse effects*
  • Diagnosis, Differential
  • Female
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / drug therapy
  • Heart Defects, Congenital / surgery
  • Heart Septal Defects, Ventricular / complications
  • Heart Septal Defects, Ventricular / drug therapy
  • Heart Septal Defects, Ventricular / surgery
  • Humans
  • Infant, Newborn
  • Infusions, Intravenous
  • Pigmentation Disorders / chemically induced
  • Pigmentation Disorders / diagnosis*
  • Pigmentation Disorders / pathology
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / adverse effects*
  • Pulmonary Atresia / complications
  • Pulmonary Atresia / drug therapy
  • Pulmonary Atresia / surgery
  • Transposition of Great Vessels / complications
  • Transposition of Great Vessels / drug therapy
  • Transposition of Great Vessels / surgery


  • Platelet Aggregation Inhibitors
  • Alprostadil