eMedicine Specialties > Dermatology > Pediatric Diseases

Ichthyosis Vulgaris, Hereditary and Acquired: Treatment & Medication

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Contributor Information and Disclosures

Updated: Jul 21, 2009

Treatment

Medical Care

Hereditary ichthyosis vulgaris is a chronic disorder that may improve with age but often requires continuous therapy. The severity of acquired ichthyosis usually depends on the status of the underlying systemic condition. The main approach to treatment of both conditions includes hydration of the skin and application of an ointment to prevent evaporation. Hydration promotes desquamation by increasing hydrolytic enzyme activity and the susceptibility to mechanical forces. Pliability of the stratum corneum is also improved.

  • Topical retinoids are helpful for some patients.
  • Alpha-hydroxy acids (eg, lactic, glycolic, or pyruvic acids) are effective for hydrating the skin. They work by causing disaggregation of corneocytes in the lower levels of the newly forming stratum corneum. Lactic acid is available as a 12% ammonium lactate lotion, or it can be compounded by prescription in a concentration of 5-10% in a suitable vehicle. Twice-daily applications have shown to be superior to petrolatum-based creams for controlling of ichthyosis vulgaris.
  • Removal of scales can be aided by keratolytics (eg, salicylic acid), which induce corneocyte disaggregation in the upper stratum corneum. A commercially available 6% salicylic acid gel can be used on limited areas.
  • Over-the-counter products often contain urea or propylene glycol. Moisturizers containing urea in lower strengths (10-20%) produce a more pliable stratum corneum by acting as a humectant. Propylene glycol draws water through the stratum corneum by establishing a water gradient. Thick skin is then shed following hydration. Propylene glycol is a common vehicle in both prescription and over-the-counter preparations.
  • Topical retinoids (eg, tretinoin) may be beneficial. They reduce cohesiveness of epithelial cells, stimulate mitosis and turnover, and suppress keratin synthesis.24 Tazarotene, a topical receptor-selective retinoid, has also been effective in one small trial.25
  • Ichthyosis vulgaris is not responsive to steroids, but a mild topical steroid may be useful for pruritus.
  • Acquired ichthyosis vulgaris generally tends to improve with treatment of the underlying systemic condition.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Retinoids

Decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. Modulate keratinocyte differentiation. Have been shown to reduce risk of skin cancer formation in renal transplant patients.


Tretinoin (Retin-A, Avita)

Keratolytic agent acts by increasing epidermal cell mitosis and turnover while suppressing keratin synthesis.

Adult

Apply 0.1% cream qd/bid

Pediatric

Not established

Toxicity increases with coadministration of benzoyl peroxide, salicylic acid, and resorcinol; avoid topical sulfur, resorcinol, salicylic acid, other keratolytics, abrasives, astringents, spices and lime; toxicity increases when used in conjunction with systemic retinoids

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with excessive sunlight exposure; caution in eczema; do not apply to mucous membranes, mouth, and angles of nose; adverse effects include blistering, crusting, severe burning or erythema, and swelling of skin


Tazarotene (Tazorac)

Receptor-selective retinoid is a synthetic retinoid prodrug that is rapidly converted into tazarotenic acid. Because use of tretinoin is often hampered by its irritancy, this product may be advantageous.

Adult

Apply 0.05% gel qd for 2 wk initially; then, 3 times/wk

Pediatric

Not established

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Avoid topical agents and cosmetics that exert a drying effect; may cause burning or stinging sensations; discontinue if excessive irritation; rinse thoroughly if contact with eyes, eyelids, or mouth; may cause severe irritation in eczematous skin; photosensitivity may occur; adverse effects include localized pruritus, burning or stinging, erythema, and irritation

Humectants

Increase skin moisture.


Ammonium lactate (Lac-Hydrin) 12% cream or lotion

Alpha-hydroxy acid that also is a naturally occurring humectant in the skin. Works to moisturize the skin and reduces excessive epidermal keratinization by causing loss of adhesiveness between corneocytes. Available OTC as 12% ammonium lactate lotion (AmLactin Lotion).

Adult

Apply to affected areas bid

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adverse effects commonly include transient stinging, burning, erythema, and peeling; less frequent reactions include irritation, eczema, petechiae, dryness, and hyperpigmentation

More on Ichthyosis Vulgaris, Hereditary and Acquired

Overview: Ichthyosis Vulgaris, Hereditary and Acquired
Differential Diagnoses & Workup: Ichthyosis Vulgaris, Hereditary and Acquired
Treatment & Medication: Ichthyosis Vulgaris, Hereditary and Acquired
Follow-up: Ichthyosis Vulgaris, Hereditary and Acquired
Multimedia: Ichthyosis Vulgaris, Hereditary and Acquired
References
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References

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Further Reading

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Keywords

ichthyosis, hereditary ichthyosis vulgaris, acquired ichthyosis vulgaris, acquired ichthyosis, hereditary ichthyosis, congenital ichthyosis, autosomal dominant ichthyosis, ichthyosis simplex, xeroderma, pityriasis vulgaris, ichthyosis nacrée, ichthyosis nacree, ichthyosis nitida, fish-skin disease, fish skin disease, retention hyperkeratosis, ichthyosis

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Albert C Yan, MD, Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania
Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, Society for Investigative Dermatology, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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