From the Guidelines
The most effective treatment for ichthyosis is acitretin, a retinoid that has been shown to remove scales, thin hyperkeratosis, and improve associated conditions such as hypohidrosis and ectropion. According to the European guidelines of care for congenital ichthyoses, published in the British Journal of Dermatology in 2019 1, acitretin is the drug of choice for treating severe forms of ichthyosis, including harlequin ichthyosis and lamellar ichthyosis. The efficacy of acitretin has been demonstrated in several pilot studies and case series, making it the preferred treatment option over other retinoids.
Some key benefits of acitretin include:
- Removing scales and thinning hyperkeratosis
- Improving hypohidrosis
- Promoting hair regrowth
- Improving ectropion and other associated conditions As noted in the study published in the British Journal of Dermatology 1, acitretin is the only retinoid approved by the European Medical Agency (EMA) for treating congenital ichthyoses, highlighting its safety and efficacy profile.
In addition to acitretin, other treatments such as moisturizing and exfoliating approaches can be used to manage ichthyosis, including:
- Daily application of thick moisturizers or emollients
- Keratolytic agents containing urea, salicylic acid, or alpha-hydroxy acids
- Bathing in lukewarm water followed by gentle exfoliation
- Maintaining humidity in the home environment using humidifiers However, for severe cases, acitretin remains the most effective treatment option, and its use should be considered under medical supervision due to potential side effects.
From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails. The best treatment for ichthyosis mentioned in the drug label is urea (TOP), as it is useful for the treatment of hyperkeratotic conditions including ichthyosis 2.
- Urea can be used to promote normal healing and debridement of hyperkeratotic surface lesions.
- It is essential to note that the label does not compare the effectiveness of urea with other treatments for ichthyosis, so it cannot be concluded that urea is the best treatment overall.
From the Research
Treatment Options for Ichthyosis
- Topical 10% urea-based lotion has been shown to be effective in reducing scaling, roughness, redness, and cracking in patients with ichthyosis vulgaris, with a 65% relative reduction in SRRC score compared to a 40% reduction with glycerol-based emollient cream 3.
- Systemic retinoids, such as acetretin, isotretinoin, and etretinate, have been used to treat ichthyosiform disorders and are considered the mainstay of therapy for ichthyosis and related skin types 4.
- Consensus recommendations for the use of retinoids in ichthyosis and other disorders of cornification in children and adolescents have been established, taking into account the need for long-term use and potential side effects 5.
- Urea-based creams with 10% urea, ceramides, and other ceramides are often the first line therapy in ichthyosis vulgaris, with ammonium lactate 12% lotion and physiological lipid-based repair cream also being effective in alleviating symptoms 6.
- Newer treatments, such as risankizumab, an anti-interleukin-23 drug, and enhancement of natural moisturizing factors, are being researched and show promise in treating ichthyosis 6.
Diagnostic and Therapeutic Approach
- Diagnosis of ichthyosis starts with proper anamnesis, detailed physical examination, and detection of associated analytic and/or histologic findings, with genetic testing being indispensable for diagnostic certainty and individualized therapeutic regimen 7.
- Treatment of ichthyosis typically involves facilitating desquamation and maintaining skin hydration using topical exfoliants and emollients, with replacement therapies and gene therapy approaches being developed to substitute altered proteins and lipids and potentially cure the disease 7.