Acquired ichthyosis in Adult
Alerts and Notices
Synopsis
AI may be associated with underlying malignancies, infectious, inflammatory, or metabolic disorders, or with medications. The most common associated malignancy is Hodgkin disease. Other less frequent associations include multiple myeloma, cutaneous T-cell lymphoma and other lymphoproliferative disorders, leiomyosarcoma, Kaposi sarcoma, and carcinomas of the breast, lung, liver, and bladder. Skin changes are most often noted following the diagnosis of the malignancy.
AI is often seen in human immunodeficiency virus (HIV) infection, usually with a low CD4+ count, and not necessarily associated with malignancy. It has also been reported in the setting of active tuberculosis infection.
Acquired ichthyosis may be seen with chronic metabolic disturbances (malnutrition, malabsorption, renal failure, hyperparathyroidism, hypopituitarism, hypothyroidism, and diabetes). It also occurs on occasion with connective tissue disease (eg, systemic lupus and dermatomyositis) as well as with sarcoidosis, Hansen disease (leprosy), and post-bone marrow transplant.
Drug-induced acquired ichthyosis may be caused by cholesterol-lowering agents, isoniazid, acitretin, butyrophenones, dixyrazine, maprotiline, cimetidine, allopurinol, hydroxyurea, and clofazimine.
Coincident hair loss may occur, as may pruritus or a burning sensation. Symptoms usually improve in a warm, moist climate.
Disease severity may parallel the course of the associated disorder. Acquired ichthyosis often remits after treatment of underlying malignancy.
Codes
ICD10CM:L85.0 – Acquired ichthyosis
SNOMEDCT:
8691004 – Acquired ichthyosis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- In males, consider X-linked ichthyosis, which has a darker scale and does not spare the flexural areas.
- Ichthyosis vulgaris – Distinguish by age of onset, as acquired ichthyosis presents later in life whereas ichthyosis vulgaris may often be seen in infancy or childhood.
- Eczema craquelé
- Xerosis
- Atopic dermatitis
- Lamellar ichthyosis
- Ichthyosiform presentation of sarcoidosis
- Allergic contact dermatitis or irritant contact dermatitis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/12/2019
Last Updated:09/15/2019
Last Updated:09/15/2019
Patient Information for Acquired ichthyosis in Adult
Overview
Acquired ichthyosis is a rare skin condition that appears in adulthood. It is usually caused by a medical condition or the use of certain medications. The affected skin is very dry, rough, and can look like fish scales.Ichthyosis can be caused by systemic illnesses such as cancer, human immunodeficiency virus (HIV) infection, diabetes, kidney disease, thyroid disease, connective tissue disease, sarcoidosis, leprosy, and bone marrow transplant.
Acquired ichthyosis may also be brought on by drugs, including some cholesterol-lowering agents, antipsychotic medications, antidepressants, and cancer therapies. Cimetidine (used to treat acid reflex) and allopurinol (used to treat gout and kidney stones) may also cause these skin changes.
Symptoms usually go away after the underlying illness is treated or the medication is no longer being used.
Who’s At Risk
A person with a systemic illness, or taking medication for a systemic illness, is at risk of developing acquired ichthyosis. People with lowered immune systems, such as HIV-infected patients, are also at risk.Signs & Symptoms
Acquired ichthyosis is very dry skin that appears in adulthood, especially after being diagnosed with a systemic illness. The affected skin has a "fish scale" appearance with rough patches that may be white, brown, or gray. Ichthyosis typically affects the trunk, limbs, and scalp.Self-Care Guidelines
A daily skin care routine to keep your skin well-hydrated and exfoliated can ease symptoms. Frequent, regular use of moisturizing creams is recommended.When to Seek Medical Care
Contact your health care provider if your skin splits or cracks, as that can lead to infection, or if your self-care is not providing adequate relief.Treatments
To reduce scale, your doctor might prescribe or recommend a cream or ointment that contains one of the following:- Alpha hydroxy acid
- Salicylic acid
- Urea
Acquired ichthyosis in Adult