Hereditary and Acquired Ichthyosis Vulgaris Treatment & Management

Updated: Jun 13, 2018
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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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. Note the following:

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. A new urea topical formulation applied to hyperkeratotic and dry skin in these patients compared favorably with a standard emollient cream. [43]

A urea-based emulsion composed of 10% urea, ceramides, and natural moisturizing factors used twice daily may be beneficial. [44] Urea helps maintain skin hydration and may have a role in assisting the regulation of epidermal genes used for proper barrier function. [45]

Topical retinoids (eg, tretinoin) may be beneficial. They reduce cohesiveness of epithelial cells, stimulate mitosis and turnover, and suppress keratin synthesis. [46] Tazarotene, a topical receptor-selective retinoid, has also been effective in one small trial. [47]

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.

Studies are being designed to quantify and compare the physiochemical properties of various topical emollients with the most desirable attributes to treat ichthyosis vulgaris. [48]

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Prevention

In many patients, scaling can be controlled by diligent and consistent treatment.

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