Ichthyosis vulgaris: Diagnosis and treatment

How do dermatologists diagnose ichthyosis vulgaris?

A dermatologist can often diagnose ichthyosis vulgaris by looking at a patient’s skin.

To make this diagnosis, your dermatologist will also ask a few questions. Before your appointment, it can be helpful to make sure you have answers to the following questions:

• Do blood relatives in your (your child’s) family have a similar skin condition?

• How old were you (your child) when the skin condition began?

• Do you (your child) have any other skin conditions?

• Do you (your child) have any other medical conditions?

• What medicines and supplements do you (or your child) take?

Sometimes, ichthyosis vulgaris looks like another skin condition. If this happens, your dermatologist can remove a small amount of skin so that it can be looked at under a microscope. This is called a skin biopsy. Your dermatologist can quickly and easily remove the skin during an appointment.

How do dermatologists treat ichthyosis vulgaris?

There is no cure for inherited ichthyosis vulgaris. Treatment focuses on reducing the scale and dry skin. To do this, a treatment plan may require you to:

• Take baths as often as directed. Soaking helps hydrate your skin and soften the scale.

If you have open sores, your dermatologist may recommend placing petroleum jelly or another product on these before getting into the water. This can reduce the burning and stinging caused by the water.

Some patients say that adding sea salt (or table salt) to the water reduces the burning and stinging. Adding salt may also reduce the itch.

• Reduce the scale during your baths. Soaking in water softens the scale. Your dermatologist may recommend that you reduce the scale while it’s softer by gently rubbing the scale with an abrasive sponge, buff puff, or pumice stone.

• Apply moisturizer to damp skin within two minutes of bathing. Moisturizer can seal water from a bath or shower into your skin. Your dermatologist may recommend a moisturizer that contains an active ingredient like urea, alpha hydroxyl acid, or lactic acid. These and other active ingredients can also help reduce scale.

• Apply petroleum jelly to the deep cracks. This can help get rid of the deep cracks.

• Treat a skin infection. If you develop a skin infection, your dermatologist will treat it with medication that you either take or apply to your skin.

If you get frequent skin infections, your dermatologist may recommend adding a small amount of bleach to your bath. Called bleach bath therapy, this can help reduce the bacteria on your skin. You should only use bleach bath therapy if your dermatologist recommends it.

If the ichthyosis is severe and fails to improve with baths, moisturizer, and scale remover, your dermatologist can prescribe medicine.

Soaking, moisturizing, and removing the scale can also get rid of the rough bumps on the skin, known as keratosis pilaris.

Some people only need to treat their skin in the winter

If the ichthyosis is mild, you may need to treat it only during the winter. In humid climates, most ichthyosis improves. A mild case can clear completely, returning in the winter when the air is dry.

What is the outlook for someone who has ichthyosis vulgaris?

For people who have the inherited type, the outlook is excellent. Most have a normal lifespan. Ichthyosis vulgaris also can become less serious with age. Most people, however, need to continue treating their skin for life.

To improve acquired ichthyosis vulgaris, you must also treat the disease that triggered the ichthyosis. If the disease can be cured, the ichthyosis may go away. If a medicine triggered the ichthyosis, reducing the dose often gets rid of the ichthyosis.

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References
Fleckman P and DiGiovanna JJ. “The ichthyoses.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:401-424.

James WD, Berger TG, et al. “Genodermatoses and congenital anomalies.” In: James WD, Berger TG, et al. Andrews' Diseases of the Skin, Clinical Dermatology (tenth edition), Elsevier, Canada, 2006:560-1.

Patel N, Spencer LA, et al. “Acquired ichthyosis.” J Am Acad Dermatol. 2006;55(4):647-56.

Richard G and Ringpfeil F. “Ichthyoses, erythrokeratodermas, and related disorders.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:743-9.

Schwartz RA. “Hereditary and Acquired Ichthyosis Vulgaris.” Medscape. Last accessed July 15, 2016.