What are the treatment options for ichthyosis?

From the Guidelines

Treatment for ichthyosis should prioritize a multi-faceted approach including daily moisturizing, keratolytic agents, and in severe cases, prescription retinoids like acitretin, to manage symptoms and improve quality of life. The primary approach involves daily moisturizing with thick emollients like petroleum jelly, Eucerin, Aquaphor, or CeraVe applied immediately after bathing to trap moisture 1. Keratolytic agents containing urea (10-40%), salicylic acid (2-6%), or alpha-hydroxy acids like lactic acid (5-12%) help reduce scale buildup by breaking down excess keratin. For more severe cases, prescription retinoids such as acitretin may be recommended to regulate skin cell production, with a typical dosage of 10-25 mg per day, and should be prescribed only by dermatologists experienced in its management 2.

Some key considerations for managing ichthyosis include:

• Daily moisturizing with emollients to improve skin hydration
• Use of keratolytic agents to reduce scale buildup
• Prescription retinoids like acitretin for severe cases, with careful monitoring for side effects
• Gentle exfoliation using soft cloths or mild chemical exfoliants to remove dead skin cells
• Maintaining humidity in the home environment (40-60%) and taking short, lukewarm showers rather than hot baths to prevent further drying 3.

It's also important to note that treatment must be consistent and tailored to the specific type of ichthyosis, as the condition results from genetic mutations affecting skin cell turnover or barrier function. While these approaches won't cure the underlying condition, they can significantly improve skin appearance, comfort, and quality of life 4.

From the FDA Drug Label

For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). 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.

Treatment options for ichthyosis include:

• Salicylic acid (TOP): a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders, including the various ichthyoses 5
• Urea (TOP): useful for the treatment of hyperkeratotic conditions, including ichthyosis 6

From the Research

Treatment Options for Ichthyosis

• Topical moisturizers and keratolytics are the mainstay of treatment for ichthyosis, as stated in 7
• Calcipotriene, retinoids, and anti-inflammatories such as topical steroids and calcineurin inhibitors have also been used to treat ichthyosis, as mentioned in 7
• Urea-based creams with 10% urea, ceramides, and other ceramides are often the first line therapy in ichthyosis vulgaris, as reported in 8
• Ammonium lactate 12% lotion with a physiological lipid-based repair cream can help with scaling and dryness, as stated in 8
• Propylene glycol solutions have also shown evidence of being beneficial in treating ichthyosis, as mentioned in 8
• Risankizumab, an anti-interleukin-23 drug, and enhancement of natural moisturizing factors are two highly promising solutions that require additional research, as reported in 8
• Topical medications cannot cure the scaling, but can gradually reduce it and thus improve the condition, as stated in 9
• 70% glycolic acid chemical peels can be used as an adjunctive biannual maintenance regime in combination with other topical therapies, as reported in 10

Systemic Therapy

• Systemic therapy is limited to the retinoids, as mentioned in 7
• Systemic therapy may be necessary in more severe cases of ichthyosis, as stated in 11

Additional Considerations

• Superinfection of the skin should be anticipated and treated, as mentioned in 7
• Pruritus can be disabling and should be addressed, as stated in 7
• Failure to sweat normally may result in heat intolerance, as reported in 7
• Eye care should seek to prevent corneal changes resulting from ectropion and more specific changes associated with specific disorders, as mentioned in 7
• Hearing can be impaired by the accumulation of material in the external auditory canal, as stated in 7
• Severely affected children may require caloric supplementation to avoid growth retardation, as reported in 7