Thick shield like taut skin all over body with cracked pinkish areas in between, scanty hair, malformed ears, everted eyelids with exposed swollen conjunctiva, slit like nostril, open mouth, flexed limbs with malformed palms, oedematous feet were present. Baby did not need active resuscitation and was shifted to neonatal intensive care unit. Dermatological opinion was taken and a diagnosis of Harlequin ichthyosis was made. Baby was managed with intravenous fluids, intravenous antibiotics and topical emollients. Baby remained haemodynamically stable with cracks in the skin increasing [Table/Fig-2]. Baby was taken to home against medical advice on fifth day of life and lost to follow-up.