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Acquired Ichthyosis

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Last updated: January 2024

What is acquired ichthyosis?

Individuals with acquired ichthyosis develop dry, scaly skin. Ichthyosis is derived from the Greek word ‘fish’ because the scaly skin in individuals with ichthyosis can resemble fish scales.

Who gets acquired ichthyosis?

Acquired ichthyosis is a non-hereditary skin condition. Although some forms of ichthyosis may be present from birth, individuals often develop acquired ichthyosis later in life – typically adulthood.

What causes acquired ichthyosis?

There are many triggers for acquired ichthyosis including nutritional deficiencies, infections, internal diseases, exposure to chemicals, and some medications. Some causes may include:

Acquired ichthyosis associated with cancers

The most common cancer associated with acquired ichthyosis is Hodgkin’s disease (a lymphoma). Skin changes may occur prior to, during and post treatment of the lymphoma.

Other cancers associated with acquired ichthyosis includes:

  • Blood cancers: non-Hodgkin’s lymphoma, multiple myeloma, cutaneous T cell lymphoma
  • Solid tumours: kaposi sarcoma, kidney cancer, lung cancer, breast cancer

Acquired ichthyosis and other diseases

Acquired ichthyosis can be caused by autoimmune conditions, nutritional deficiencies, metabolic diseases, or infections.

Malnutrition or malabsorption diseases such as Crohn’s disease, pancreatic sufficiency, and coeliac disease, may lead to poor absorption of fats and vitamins and development of acquired ichthyosis.

Other conditions, including chronic liver disease, kidney failure, thyroid and parathyroid diseases, sarcoidosis, leprosy, bone marrow-related conditions and autoimmune connective tissue diseases, such as lupus and dermatomyositis, may also cause acquired ichthyosis.

Infections such as acquired immunodeficiency syndrome (AIDS) and lepros have been associated with acquired ichthyosis.

Drug-induced ichthyosis

Certain medications may cause acquired ichthyosis, including:

  • Lipid-lowering agents: statins, nicotinic acid
  • H2 blocker: cimetidine
  • Allopurinol

What does acquired ichthyosis look like?

The skin of individuals with acquired ichthyosis may range from small, dry fine scales to large, thick plates of scale which may be raised at the edges. Dry and cracked skin may be painful and prone to bleeding.

The colour of the scales may change from white and brown to grey. Lesions are most often seen on knees and elbows but can also be seen on the trunk. The face and body folds are rarely affected.

How is acquired ichthyosis diagnosed?

Acquired ichthyosis may be diagnosed from a medical history and skin examination.

In some cases, a skin biopsy may be required. Once acquired ichthyosis is diagnosed, it is important to investigate its trigger.

How is acquired ichthyosis treated?

Treatment options will vary depending on the individual and their needs.

The aim of acquired ichthyosis treatment is to hydrate the skin and prevent complications, such as infection (from the cracks in the skin).

Treatment may include:

  • Using soap-free cleansers and regular moisturisers to maintain hydration of the skin
  • Using urea, alpha-hydroxy acids, and/or salicylic acids as a part of a moisturizing routine
  • Bathing in salt or very diluted bleached water
  • Oral antibiotics for infections

In severe cases, topical or oral vitamin A-based medications called retinoids.

What is the likely outcome of acquired ichthyosis?

Acquired ichthyosis often improves when the causative drug is ceased or when the underlying condition is treated.

Dr Kelvin Truong and Prof Pablo Fernandez-PeñasJanuary 2024
Dr Shelley Ji Eun Hwang and Prof Pablo Fernandez-PeñasOctober 2020

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