From the Guidelines
Treatment for ichthyosis vulgaris should focus on regular application of emollients, at least twice a day, to improve skin hydration, as recommended by the European guidelines of care 1. The cornerstone of therapy is hydrating the skin and removing scales.
- Emollients should be applied immediately after bathing while skin is still damp to trap moisture.
- Urea (≥ 10%) can be used, but it is not recommended before the age of 1 year, except once daily on limited areas such as the palms and soles 1.
- For severe cases, systemic therapy with oral retinoids, such as acitretin, may be considered in addition to topical therapies, as it has been shown to be effective in removing scales and thinning hyperkeratosis 1.
- Daily bathing with lukewarm water for 5-10 minutes helps hydrate the skin; avoid hot water as it worsens dryness.
- Gentle soaps or soap-free cleansers are preferable.
- Humidifiers in dry environments can prevent excessive skin drying. These treatments work by increasing skin hydration, promoting normal desquamation, and reducing hyperkeratosis.
- While ichthyosis vulgaris cannot be cured, consistent treatment significantly improves skin appearance and reduces symptoms like itching and cracking. It is essential to note that the treatment should be tailored to the individual patient's needs, and the preferred emollient may vary among patients 1.
- Systemic therapy, such as oral retinoids, should be considered in case topical therapies are insufficiently effective or patients need respite from excessive topical treatment 1.
From the Research
Treatment Options for Ichthyosis Vulgaris
- Urea-based creams with 10% urea are often the first line therapy in ichthyosis vulgaris, as they have been shown to be highly therapeutic 2
- Ceramides and other ceramides can also be used to help alleviate symptoms 2
- Ammonium lactate 12% lotion with a physiological lipid-based repair cream can help with scaling and dryness 2
- Propylene glycol solutions have also been shown to be effective in treating ichthyosis vulgaris 2
- Risankizumab, an anti-interleukin-23 drug, and enhancement of natural moisturizing factors are two highly promising solutions that require additional research 2
Topical Treatments
- Moisturizers and keratolytics are the mainstay of topical therapy for ichthyosis vulgaris 3
- Calcipotriene, retinoids, and anti-inflammatories such as topical steroids and calcineurin inhibitors have also been used to treat ichthyosis vulgaris 3
- Topical treatments cannot cure the scaling, but can gradually reduce it and thus improve the condition 4
- A urea-based emulsion containing 10% urea, ceramides, and natural moisturizing factors (NMF) has been shown to be effective in treating ichthyosis vulgaris, with significant clinical improvement of xerosis and reduction of itch 5
Efficacy of Urea-Based Treatments
- A study comparing a 10% urea-based lotion to a glycerol-based emollient cream found that the urea-based lotion was more effective in reducing scaling, roughness, redness, and cracking 6
- The urea-based lotion was also found to be well tolerated, with a similar tolerability profile to the glycerol-based emollient cream 6
- Another study found that a urea-based emulsion containing 10% urea, ceramides, and NMF was effective in treating xerosis in patients with ichthyosis vulgaris, with significant clinical improvement and reduction of itch 5