Ichthyosis vulgaris

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Overview
Ichthyosis vulgaris is a skin disorder causing dry, scaly skin.

It is the most common form of ichthyosis, affecting around 1 in 250 people . For this reason it is known as common ichthyosis. It is also referred to as fish skin disease on account of its appearance.

It is overwhelmingly a dominant inherited disease (often associated with filaggrin), although a very rare variant, acquired ichthyosis vulgaris, is not inherited.

Presentation
The symptoms of the inherited condition manifest themselves at around four years old. The symptoms will often improve with age, although they may grow more severe again in old age.

The acquired variant usually becomes evident during adulthood.

The condition is not life-threatening; the impact on the patient, who has a mild case, is generally restricted to mild itching and the social impact of having skin with an unusual appearance. People afflicted with "mild" cases have symptoms which include " mosaic lines" or scaly patches on the shins, fine white scales on the forearms and rough palms.

However, severe cases, although rare, do exist. Severe cases would entail the build up of scales everywhere, with areas of the body that have a concentration of sweat glands being least affected. Areas where the skin rubs against each other, such as the arm pits, the groin, and the "folded" areas of the elbow and knees, would also be less affected. When the build up of scales is bad, the person with a severe case would suffer from "prickly itch" when he or she needs to sweat but cannot as a result of the scales. Various topical treatments are available to "exfoliate" the scales. These include various lotions that contain alpha-hydroxy acids.

Risk factors
The climate or weather where someone afflicted with severe cases live will have a deterministic impact on the condition.

Paradoxically, those at risk of "prickly itch" should seek rather than avoid hot and humid climate. Living year-round in a tropical climate would facilitate sweating; sweating would in turn facilitate the clearing of the scales and keep the condition leading to "prickly itch" at bay.

On the other hand, cold and dry climate has the opposite effect. Not only would harsh winters inhibit sweating, but they would contribute to the build up of scales. Overexposure to strong air-conditioning and overconsumption of alcohol would also aggravate the build up of scales, and heighten the risk of "prickly itch."