Ichthyosis Medication

Updated: Aug 28, 2018
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Oral retinoids display an impressive antikeratinizing action in ichthyosiform dermatoses. Acitretin (25-50 mg/d) and Isotretinoin (0.5-2 mg/kg/d) have been shown to reduce scaling, discomfort, and disfigurement. However, when these drugs are discontinued, the ichthyotic skin recurs, thereby necessitating long-term use.

Liarozole (150 mg bid), an imidazole derivative, inhibits the cytochrome P450-dependent 4-hydroxylation of retinoic acid, resulting in increased tissue levels of retinoic acid and a reduction in epidermal proliferation and scaling. It is a broad-spectrum antifungal agent; inhibits cytochrome P450 metabolic pathways, increasing levels of cytochrome P450 metabolized drugs. The US FDA has not approved this medication for use. Patients with epidermolytic hyperkeratosis may develop chronic bacterial infections of the skin necessitating long-term antibiotic therapy.

N-acetylcysteine 10% emulsion, a nontoxic and hypoallergenic amino acid derivative, can be safely and efficaciously used in the topical treatment of neonatal ichthyosis.

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Retinoid-like Agents

Class Summary

These agents decrease cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. They modulate keratinocyte differentiation and have been shown to reduce risk of skin cancer formation in renal transplant patients.

Isotretinoin (Amnesteem, Claravis, Sotret)

The synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A.

Acitretin (Soriatane)

Metabolite of etretinate and related to retinoic acid and retinol (vitamin A). Mechanism of action unknown but thought to exert therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.

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Antibiotics

Class Summary

Patients with epidermolytic hyperkeratosis may develop chronic bacterial infections of the skin necessitating long-term antibiotic therapy.

Erythromycin (EES, Ery-Tab, Erythrocin)

This is for patients with epidermolytic hyperkeratosis who develop bacterial infections of the skin.

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Keratolytic agents

Class Summary

These agents are used to prevent cicatricial ectropion in lamellar ichthyosis, a humidified atmosphere combined with the use of topical moisturizing agents is beneficial. Petrolatum ointment and 10% urea cream applied to the eyelid skin several times daily helps to prevent skin contracture. Salicylic acid 2% and retinoic acid 0.1% ointments are also effective, but local irritation may limit their frequency of use.

Urea (Ureacin, Carmol, Keralac)

Promotes hydration and removal of excess keratin in conditions of hyperkeratosis.

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Ophthalmic Lubricants

Class Summary

In chronic ocular surface disorders associated with ichthyosis, nonpreserved artificial tears (carboxymethylcellulose sodium 0.5-1.0%) and ointment (white petrolatum 56.8%, mineral oil 41.5%) are preferred to prevent complications from dryness and exposure. Preservative-free lubricants may be used as often as needed while decreasing the incidence of preservative-related allergies. In cases where poor corneal epithelial adhesion is present, bandage contact lenses and temporary collagen shields may decrease symptoms and promote surface healing.

Carboxymethylcellulose ophthalmic (Refresh Optive Gel Drops, TheraTears Nighttime Dry Eye Therapy)

Lubricates and relieves dry eyes and eye irritation associated with deficient tear production.

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Mucolytic Agents

Class Summary

Agents in this category may prove effective in the topical treatment of neonatal ichthyosis.

N-acetylcysteine (Acetadote)

N-acetylcysteine is a glutathione precursor. It may provide effective photoprotection by increasing the availability of glutathione, a potent antioxidant. A nontoxic 10% emulsion and hypoallergenic amino acid derivative can be safely and efficaciously used in the topical treatment of neonatal ichthyosis.

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