Ichthyosis vulgaris

Overview

Ichthyosis is a skin disease that encompasses over 20 different types with Ichthyosis vulgaris being the most prevalent and least severe among them. Among individuals with any form of ichthyosis, 95% specifically have ichthyosis vulgaris.

The primary characteristic of ichthyosis vulgaris is the presence of dry, thickened, and scaly skin. This condition typically initiates in childhood, frequently manifesting within the first year of life. However, it can also develop in adults.

Ichthyosis vulgaris is relatively common, impacting approximately one in every 250-300 individuals, irrespective of gender or race.

It is also referred to as “fish scale disease” due to the accumulation of dead skin resembling the pattern of fish scales.

Symptoms

The symptoms of ichthyosis vulgaris remain consistent, regardless of whether it is inherited or acquired. Common symptoms include:

• Dry, itchy skin
• Thick and coarse skin, particularly noticeable on the palms and soles of the feet.
• Presence of white, gray, or brown scales on areas such as the front of the legs, back of the arms, scalp, back, or stomach. If scales manifest on the face, they tend to concentrate on the forehead and cheeks, with possible curling at the edges, resulting in a rough texture.
• Development of additional lines on the palms and soles, which may become deeply etched in severe cases, leading to skin cracks. Deep cracks can potentially lead to infections.
• Rough bumps commonly found on the arms, thighs, and buttocks, known as keratosis pilaris, are frequently misidentified as acne lesions.
• Reduced ability to perspire adequately, particularly in severe cases, which can lead to overheating due to a lack of the cooling effect provided by perspiration.

Some individuals may not recognize their ichthyosis vulgaris due to mild symptoms, attributing it to dry skin and using moisturizers, which can alleviate scaling. Aggravation of ichthyosis vulgaris symptoms during winter, exacerbated by cold and dry air. Conversely, symptoms may virtually disappear in the summer due to the presence of warm, moist air.

Onset of ichthyosis vulgaris symptoms may precede the diagnosis of more serious diseases in some patients. Conversely, symptoms may emerge years after patients have been diagnosed with more severe conditions.

Causes

Ichthyosis vulgaris is predominantly attributed to genetic factors, commonly inherited from one’s parents. Nevertheless, some individuals may acquire ichthyosis vulgaris due to underlying medical conditions or as a reaction to certain medications.

In individuals with ichthyosis vulgaris, skin cells reproduce at a normal rate, but they fail to separate properly at the skin’s surface. Additionally, there is a delayed shedding of dead skin cells, leading to the accumulation of scales.

In the case of children with ichthyosis vulgaris, it is often linked to an inherited gene from one or both parents, a condition referred to as inherited ichthyosis vulgaris. Importantly, parents need not exhibit the disease themselves to pass the gene to their children. A child inheriting the ichthyosis vulgaris gene faces a 50% likelihood of developing the condition.

Another potential cause of ichthyosis vulgaris involves a gene mutation occurring during fetal development. In such instances, the child’s skin lacks an adequate amount of a crucial protein called filaggrin, which plays a key role in the formation of the outermost skin layer and the timely shedding of dead skin cells.

In the case of adults, the condition is termed acquired ichthyosis vulgaris, and it may result from various underlying diseases. These include conditions such as kidney failure, specific cancers, sarcoidosis, leprosy, and Human Immunodeficiency Virus (HIV). In rare instances, acquired ichthyosis vulgaris can also be triggered by certain medications, such as cimetidine, utilized for treating ulcers and acid reflux, and clofazimine, which is employed in leprosy treatment. Alternatively, it may be induced by the consumption of specific vitamins, such as nicotinic acid.