Cambio de Color Arlequin: breve revisión de la literatura

Harlequin Color Change: a brief literature review

Contenido principal del artículo

Esther Pinel Guzmán
Brayan Julián Martínez Fernández


Introduction: in 1952, Neligan and Strange first described a rare phenomenon, which occurs in the neonatal period and is characterized by a sudden change in skin color, with a straight line dividing half of the body as if it had been “drawn with a pencil and ruler” running down the midline, with one half of the body erythematous and the other pallor.

Objective: to present literature related to the Harlequin color change phenomenon and its different clinical presentations.

Methods: a non-systematic review of the available literature was conducted using key terms such as “Harlequin Color Change”, “Harlequin Newborn”, “Harlequin Color Change NOT Syndrome NOT ichthyosis” using other Boolean operators such as “AND” and “OR”, both in English and Spanish, in the PubMed, ScienceDirect, and Google Academics databases.

Results: Harlequin Color Change is characterized by an appearance of skin divided into two distinctly colored areas. Its etiology is unknown but thought to be caused by immaturity of hypothalamic regulation of peripheral vascular tone. It affects approximately 10% of healthy neonates.

Conclusion: Harlequin Color Change is a benign, idiopathic, and self-limited condition that does not need treatment. The physician must recognize this phenomenon, which has a variety of color change patterns. It is essential to inform parents of this harmless and temporary skin condition to prevent needless testing and treatment. Not to be confused with ichthyosis Harlequin.

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Detalles del artículo

Biografía del autor/a (VER)

Esther Pinel Guzmán, Universidad Católica de Honduras

School of Medicine, Universidad Católica de Honduras, Tegucigalpa.

Brayan Julián Martínez Fernández, Universidad Católica de Honduras

School of Medicine, Universidad Católica de Honduras, Tegucigalpa.

José Rafael Pinel Dubón, Hospital General del Sur

Pediatric critical care physician, PICU, Hospital General del Sur, Choluteca, Honduras.

Referencias (VER)

Neligan GA, Strang LB. A “Harlequin” Colour Change in the Newborn. Lancet. 1952;2(6743):1005–7. Available from:

Valerio E, Barlotta A, Lorenzon E, Antonazzo L, Cutrone M. Harlequin Color Change: Neonatal Case Series and Brief Literature Review. Am J Perinatol Reports. 2015;5(01):e73–6. Available from:

Dewangan M. Harlequin colour change in a neonate with perinatal asphyxia: An unusual pattern. J Pediatr Sci. 2016;8:1–3. Available from:

Lee RS, Wan H, Chan RL. Harlequin colour change in a newborn with meningitis. Hong Kong Med J. 2012;18(6):6–7. Available from:

Rao J, Campbell ME, Krol A. The harlequin color change and association with prostaglandin E1. Pediatr Dermatol. 2004;21(5):573–6. Available from:

Januário G, Salgado M. The Harlequin phenomenon. J Eur Acad Dermatology Venereol. 2011;25(12):1381–4. Available from: 3083.2011.04124.x

Dang D, Zhou W, Liu Y, Wu H. Harlequin color change in two preterm newborns. J Dermatol. 2014;41(1):102–3. Available from: 8138.12277

Selimoglu MA, Dilmen U, Karakelleoglu C, Bitlisli H, Tunnessen WW, Board A. Picture of the Month. Harlequin Color Change. ARCH PEDIATR ADOLESC MED. 1995;149(10):1171–2. Available from:

Garg S, Joshi A, Mehta S. Novel presentation of harlequin phenomenon (simultaneous cyanotic mottling and frightening pallor [vasospasm] of one limb). J Clin Neonatol. 2019;8(2):131–2. Available from:

Van Den Berg G, Bakker H. Harlequin Color Change in a Neonate. N Engl J Med. 2020;382(5):456. Available from:

Hamida E Ben, Ayadi ID. Harlequin color change in preterm infant. Pan Afr Med J. 2015;22(119):8688. Available from:

Velayuthan S, Sankararaman S. Newborn who has unilateral color change. Pediatr Rev. 2013;34(7):2013–6. Available from:

Mortensen OLE, Stougard-Andresen P. Harlequin Colour Change in the Newborn. Acta Obs Gynecol Scand. 1959;38:352–8. Available from:

Wagner D, Sewell A. Harlequin Color Change in an Infant during Anesthesia. Anesthesiology. 1985;62(5):695. Available from:

Pearson HA, Cone TE. Harlequin color change in a young infant with tricuspid atresia. J Pediatr. 1957;50(5):609–12. Available from:

Morrison DA, Bibby K, Woodruff G. The “harlequin” sign and congenital Horner’s syndrome. J Neurol Neurosurg Psychiatry. 1997;62(6):626–8. Available from:

Zelnik N, Nir A, Amit S, Iancu TC. Autonomic Seizures in an Infant: Unusual Cutaneous and Cardiac Manifestations. Dev Med Child Neurol. 1990;32(1):74– 8. Available from: 8749.1990.tb08470.x

Padda GS, Cruz OA, Silen ML, Krock JL. Skin conductance responses in paediatric Harlequin syndrome. Paediatr Anaesth. 1999;9(2):159–62. Available from:

Kerbl R, Schwinger W, Lackner H, Dornbusch HJ, Urban CE. Peripheral harlequin-like thermal imbalance after Wilms’ tumor. J Pediatr. 2000;137(6):887. Available from:

Turco G, Farber N. Postoperative Autonomic Deficit: A Case of Harlequin Syndrome. Anesthesiology. 1996;85(5):1197–9. Available from:

Breunig J de A, Hartmann M, Freire CF, Almeida Jr HL de. Harlequin syndrome in childhood: Case Report. An Bras Dermatol. 2012;87(6):907–9. Available from:

Sabir H, Babor F, Kieseier BC, Mayatepek E, Assmann B. Unilateral Facial Flushing and Sweating After Physical Exercise: Harlequin Syndrome. Klin Padiatr. 2011;223(2):90–1. Available from:

Elboukhari K, Baybay H, Elloudi S, Douhi Z, Mernissi FZ. Idiopathic harlequin syndrome: A case report and literature review. Pan Afr Med J. 2019;33(141):1–4. Available from:

Hans-Bittner NR, Bittner GC, Hans Filho G. Do you know this syndrome? Harlequin syndrome. An Bras Dermatol. 2018;93(4):585–6. Available from:

Tascilar N, Tekin NS, Erdem Z, Alpay A, Emre U. Unnoticed dysautonomic syndrome of the face: Harlequin syndrome. Auton Neurosci Basic Clin. 2007;137(1–2):1–9. Available from:

Tyrrell J, Trumpelmann P, Chamberlain M. Harlequin syndrome after extrapleural bupivacaine infusion. Br J Anaesth. 2012;109(2):294–5. Available from:

Pradeep P V., Benede AK, Harshita SS, Jayashree B. Harlequin syndrome in a case of toxic goitre: A rare association. Case Rep Med. 2011;2011(293076). Available from:

Sarikaya H, Georgiadis D, Baumgartner RW. Harlequin syndrome in spontaneous dissection of the cervical carotid artery. Neurology. 2008;71(18):1459. Available from:

Toll A, Gálvez-Ruiz A. Harlequin syndrome after jogging. Med J Aust. 2011;195(5):288. Available from:

Fallon KE, May JJ. Harlequin syndrome in two athletes. Br J Sports Med. 2005;39(1):1–3. Available from:

Duddy ME, Baker MR. Harlequin’s Darker Side. N Engl J Med. 2007;357(20):e22. Available from:

Moon S, Shin D, Park S, Kim J. Harlequin syndrome with crossed sympathetic deficit of the face and arm. J Korean Med Sci. 2005;20(2):329–30. Available from:

Drummond P, Lance JW. Harlequin syndrome: Does a cranial autonomic neuropathy influence headache? J Neurol Neurosurg Psychiatry. 2012;83(6):577. Available from:

Viana M, Mathias C, Goadsby P. Headache in three new cases of Harlequin Syndrome with accompanying pharmacological comparison with migrane. J Neurol Neurosurg Psychiatry. 2012;83(6):663–5. Available from:

Mashour G, Levine W, Ortiz V. Intraoperative Harlequin Syndrome. Anesth Analg. 2006;102(2):655. Available from:

Kalapesi FB, Krishnan A V., Kiernan MC. Segmental facial anhidrosis and tonic pupils with preserved deep tendon reflexes: A novel autonomic neuropathy. J Neuro- Ophthalmology. 2005;25(1):5–8. Available from:

Oller K, Cao K, Parkerson J, Lezama J. Stop, you’re making me blush. Am J Med. 2011;124(4):301–2. Available from:

Bohlega S, Stigsby B, Al Mohaileb F. Teaching Neuroimages: Harlequin syndrome caused by lesion of sympathetic regulatory neurons. Neurology. 2010;74(24):106. Available from:

Sribnick EA, Boulis NM. Treatment of Harlequin Syndrome by Costotransversectomy and Sympathectomy: Case Report. Neurosurgery. 2011;69(1):257–9. Available from:

Mashour G, Levine W, Ortiz V. Intraoperative Harlequin Syndrome. Anesth Analg. 2006;102(2):655–6. Available from:

Wasner G, Maag R, Ludwig J, Binder A, Schattschneider J, Stingele R, et al. Harlequin syndrome - one face of many etiologies. Nat Clin Pract Neurol. 2005;1(1):54–9. Available from:

Cheshire WP, Low PA. Harlequin Syndrome: Still Only Half Understood. J Neuro-Ophthalmology. 2008;28(3):169–70. Available from:

Lance JW, Drummond PD, Gandevia SC, Morris JGL. Harlequin syndrome: The sudden onset of unilateral flushing and sweating. J Neurol Neurosurg Psychiatry. 1988;51(5):635–42. Available from:

Makhija G, Gupta PK. Harlequin Color Change in a New Born. Int J Med Pediatr Oncol. 2016;2(1):40–1.

Morelli JG. Diseases of the Neonate. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editor. Nelson Textbook of Pediatrics. 20th ed. 2016. p. 3251.

Deshpande A, Tolat S. A Clinical Study of Physiological Skin Manifestations in Neonates. Int J Res Dermatology. 2017;3(1):130. Available from: 4529.intjresdermatol20170801

Tang J, Bergman J, Lam JM. Harlequin colour change: Unilateral erythema in a newborn. CMAJ. 2010;182(17):92038. Available from:

Cizmeci MN, Alagoz D, Avsar MI, Alis G, Tutanc M. Harlequin color change after abdominal paracentesis in a newborn with neonatal hemochromatosis. Pediatr Dermatol. 2014;31(6):e114–5.

Chan P M. Desafio Diagnóstico. Pediátr Panamá. 2016;45(2):31–3. Available from: 848778

Larralde M, Abad ME. Transient Skin Disorders in the Neonate and Young Infant. In: Hoeger P, Kinsler V, Yan A, editors. Harper’s Textbook of Pediatric Dermatology. 4th ed. Wilhelmstift: John Wiley & Sons Ltd.; 2019. p. 72–83. Available from:

Khemani S, Ali SB, Karim S, Yezdan MA. Harlequin colour change. J Coll Physicians Surg Pakistan. 2017;27(September):S127–8.

Demirkan S, Gündüz Ö. A different harlequin color change case. Turkiye Klin Dermatoloji. 2017;27(3):131– 3. Available from: 56994

Santos SF, De Abreu MRC. Harlequin phenomenon at birth: And she was born with a white stocking. BMJ Case Rep. 2015;2015:1–2. Available from:

Serdaroglu S, Çakil B. Physiologic Skin Findings of Newborn. J Turk Acad Dermatol. 2008;2(4):83401. Available from:

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