Medicines for Ichthyosis

What it is

Ichthyosis is the name for a group of skin conditions that cause the skin to be persistently dry, thickened, and scaly (the name comes from the Greek for "fish", reflecting the fish-scale-like appearance of the skin in some forms). The skin does not shed old cells normally, so they build up as scales. Most types of ichthyosis are genetic (inherited) and present from birth or early childhood, and are lifelong; the most common inherited form (ichthyosis vulgaris) is relatively mild and common, while other inherited types are rarer and can be more severe. Less commonly, ichthyosis can be acquired later in life, sometimes associated with another underlying condition or medicine. The main feature is dry, scaly skin, which can range from mild dryness and fine scaling to more marked thickening and scaling; it often affects large areas of the body, and the pattern and severity depend on the type. The skin may be itchy, can crack (which can be sore and, in more severe forms, risk infection), and the condition can affect comfort, appearance, and, in severe forms, other functions of the skin. Ichthyosis is usually not dangerous (though rare severe forms present at birth need specialist care), but it can be uncomfortable and have a significant impact on daily life and wellbeing. There is no cure for the inherited forms, but the condition can be well managed: the mainstay is intensive, regular skin care to keep the skin moisturised and reduce the dryness and scaling, which keeps the skin more comfortable and reduces cracking. Specialist dermatology care helps, particularly for more severe types, and support is available. The key messages are that ichthyosis is a group of (usually inherited, lifelong) conditions causing dry, scaly skin, that it is usually manageable rather than dangerous, and that regular intensive moisturising is the mainstay of keeping the skin comfortable.

How it is treated

Ichthyosis is managed mainly with intensive, regular skin care to keep the skin moisturised and reduce dryness and scaling, with specialist dermatology care for more severe types; there is no cure for the inherited forms, but the condition can be well controlled. The cornerstone of management is a good daily skin-care routine: regular and generous use of emollients (moisturisers) to hydrate the skin and soften and reduce the scaling — often applied liberally and frequently, including after bathing while the skin is still damp; using emollients as soap substitutes; and, in some cases, products containing ingredients that help remove scale (such as certain agents that help exfoliate), as advised. Bathing or soaking can help soften the skin and remove scale, followed by moisturising. This routine, though it takes time and commitment, keeps the skin more comfortable, reduces cracking and itching, and improves the appearance. For more severe or specific types of ichthyosis, a dermatologist provides specialist care, which may include stronger or specific treatments (such as certain creams, or, for some severe forms, medicines taken by mouth that affect skin cell turnover), and management of complications (such as skin cracking, infection, or, in severe forms, effects on temperature regulation or other functions). Rare severe forms present at birth need specialist neonatal and dermatology care. Managing any itching, treating any skin infections, and general skin protection are part of care. Where ichthyosis is acquired (developing later in life), looking for and addressing any underlying cause is also part of management. Because ichthyosis is usually lifelong and can affect wellbeing and daily life, support — including practical advice on skin care, and emotional and peer support (for example through ichthyosis support organisations) — is valuable, and genetic counselling is available for the inherited forms to discuss inheritance and family planning. The reassuring messages are that ichthyosis, although usually a lifelong (and often inherited) condition without a cure, is usually not dangerous and can be well managed — with regular, intensive moisturising and skin care as the mainstay of keeping the skin comfortable — and that specialist care and support are available, particularly for more severe types; so a good skin-care routine and, where needed, dermatology input are the keys to living well with ichthyosis.