By Gary M. White, MD
Ichthyosis vulgaris (IV) is the most common ichthyosis that results in diffuse fine scaling, usually worse on the legs.
- Patients may have mild-moderate palmoplantar keratoderma with hyperlinear palms and soles.
- Flexural areas are typically spared.
- Mutations in the gene encoding filaggrin are causative and also predispose to atopic dermatitis.
Severe xerosis and fine white scaling with onset in the first few months of life is characteristic. In comparison to the other ichthyoses, the skin changes of ichthyosis vulgaris are mild. The disease is worse in the winter, tends to occur on the legs and may improve with age. Inheritance is AD with variable expression within the family. An important feature histologically is an absence of the granular layer.
IV typically improves with age, in the summer and with warm, humid environments. Emollients and keratolytics are usually sufficient. Creams and ointments are more effective than lotions. Ammonium lactate 12% lotion or urea can be effective at lessening the scale.
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