The main approach to treatment includes hydration of the skin and application of an ointment to prevent evaporation. Hydration promotes desquamation by increasing hydrolytic enzyme activity and the susceptibility to mechanical forces. Pliability of the stratum corneum
is also improved.
•Topical retinoids are helpful for some patients.
•Alpha-hydroxy acids (eg, lactic, glycolic, or pyruvic acids) are effective for hydrating the skin. They work by causing disaggregation of corneocytes in the lower levels of the newly forming stratum corneum.
•Lactic acid is available as a 12% ammonium lactate
lotion, or it can be compounded by prescription in a concentration of 5-10% in a suitable vehicle. Twice-daily applications have shown to be superior to petrolatum-based creams for controlling of ichthyosis vulgaris
•Removal of scales can be aided by keratolytics (eg, salicylic acid
), which induce corneocyte disaggregation in the upper stratum corneum. A commercially available 6% salicylic acid gel can be used on limited areas.
•Over-the-counter products often contain urea or propylene glycol. Moisturizers containing urea in lower strengths (10-20%) produce a more pliable stratum corneum by acting as a humectant. Propylene glycol draws water through the stratum corneum by establishing a water gradient. Thick skin is then shed following hydration. Propylene glycol is a common vehicle in both prescription and over-the-counter preparations.
•Topical retinoids (eg, tretinoin) may be beneficial. They reduce cohesiveness of epithelial cells
, stimulate mitosis and turnover, and suppress keratin synthesis. Tazarotene
, a topical receptor-selective retinoid, has also been effective in one small trial.
•Ichthyosis vulgaris is not responsive to steroids, but a mild topical steroid
may be useful for pruritus.