Incontinentia Pigmenti (IP) is an X-linked dominant genodermatosis caused by a mutation of the NEMO or IKBKG gene. Cutaneous manifestations are common, however, involvement of the eyes, teeth, and central nervous system can also be seen. Genetic counseling plays a vital part in the management, as well as a multidisciplinary approach involving other specialties.

This is a case of a newborn female with unremarkable birth and maternal history who presented with erythematous papules, vesicles, and pustules on the trunk, upper extremities, and lower extremities upon birth. She was born term via normal spontaneous delivery to a 34-year-old G1P0 with no known personal and family history of dermatologic or other genetic conditions. On the 5th day of life, lesions started to form a whorl-like appearance, eventually turning hyperpigmented, with a blaschkoid distribution. Skin punch biopsy revealed several eosinophils on the dermis highly suggestive of IP. Dermoscopy showed polycyclic scaling with a yellowish center and erythematous halo. Genetic testing revealed a heterozygous pathogenic deletion encompassing exons 4-10 of the IKBKG gene, confirming the diagnosis of IP. Genetic counseling was done. The patient’s family was advised periodic monitoring and surveillance.

Dermoscopy in IP can provide an earlier diagnosis. Stage I shows a yellowish center and erythematous halo with yellowish serocrusts surrounded by polycyclic scaling. Only two cases of IP dermoscopy have been published so far. Dermoscopy complements histopathology in IP.