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Acquired ichthyosis in Adult
Other Resources UpToDate PubMed

Acquired ichthyosis in Adult

Contributors: Nkem Ugonabo MD, MPH, Marvin Turck MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Acquired ichthyosis (AI) is a rare condition with onset in adulthood that is usually associated with underlying disease. It is clinically similar to ichthyosis vulgaris, a benign hereditable disorder that manifests in childhood.

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
Rarer disorders:
  • 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.

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References

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Last Reviewed:09/12/2019
Last Updated:09/15/2019
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Patient Information for Acquired ichthyosis in Adult
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Acquired ichthyosis in Adult
A medical illustration showing key findings of Acquired ichthyosis : Dry skin, Ichthyotic scaly plaque, Widespread distribution
Clinical image of Acquired ichthyosis - imageId=37823. Click to open in gallery.  caption: 'Diffuse xerosis and fine adherent scales on the legs of a patient with lymphoma.'
Diffuse xerosis and fine adherent scales on the legs of a patient with lymphoma.
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