Because ichthyosis is a life-long condition, and because there is no cure, the goal of treatment is to alleviate symptoms and relieve discomfort. Two kinds of symptoms need attention: primary symptoms (thickened, dry, scaling skin, and in some cases severe blistering), and secondary problems (summarized above).
The goal in treating the primary symptoms of ichthyosis is moisturizing affected areas of skin while promoting exfoliation (normal shedding) of the skin’s outermost layer. Both goals are generally met with a regimen that includes application of topical preparations. Treatment of children with ichthyosis employs three main types of topical preparation: humectants, keratolytics, and emollients.
Humectants are a broad class of topical creams and lotions, which effectively penetrate and moisturize the skin by holding water in the stratum corneum. There are hundreds of effective humectants available over the counter and by prescription, including creams with urea and propylene glycol.
Keratolytics actively promote exfoliation by promoting the dissolution of bonds between individual cells of the stratum corneum, the outermost layer of skin. The most commonly used keratolytics are lactic acid, glycolic acid, and salicylic acid.
Emollients are skin lubricants, usually petrolatum or lanolin based. They moisturize the skin by preventing water from evaporating from the surface.
Children typically self treat their skin or receive a thorough topical treatment regimen from one to four times per day (usually combined with baths), depending on the severity of their condition.
At school, a certain amount of maintenance treatment may be necessary. For this purpose, children with ichthyosis must have on hand their essential treatment needs. Maintenance treatment generally involves periodic applications of topical moisturizing creams or lotions. Accommodations should be in place to allow the child time and privacy to do this. Preschoolers and young children may need a reminder from the teacher to apply lotion after water play, sand play, messy artwork or hand washing. However, most children know they are more comfortable when they use their lotions, and only require the necessary time and a place to do it discretely.
Of utmost importance is avoiding unnecessary self-consciousness and embarrassment. Steps must be taken to provide adequate privacy, and to avoid calling undo attention to the child’s special needs.
Children with ichthyosis are sometimes treated with oral medication. Antibiotics may be prescribed for topical or systemic infections. In cases where a child is subject to chronic itching (pruritus), antihistamines and/or topical medications may be prescribed to help manage the problem. An unfortunate side effect of most antihistamines is that they can make a child drowsy or inattentive. This is usually a temporary effect; if it persists and disrupts the child’s education, a change to an alternate class of antihistamines may be suggested.
Children with epidermolytic ichthyosis, particularly, should have a topical antibiotic on hand to apply to incidental cuts and scrapes.
Some severely affected young people may also be treated with systemic retinoids. The retinoids are vitamin A derivatives, are potent drugs, and may have some side effects. Although school personnel will probably not administer treatment, teachers and other school officials should be aware that treatment with retinoids is underway, and should be appraised by parents of the most common side effects.
Children of all ages should be encouraged to be active participants in their own treatment. Taking on the responsibility of self-care will help the child develop a sense of independence, control, and competence, all of which help the child meet the normal developmental tasks of childhood.
This information is provided as a service to patients and parents of patients who have ichthyosis. It is not intended to supplement appropriate medical care, but instead to complement that care with guidance in practical issues facing patients and parents. Neither the Foundation for Ichthyosis & Related Skin Types, Inc. (FIRST) Board of DIrectors, Publications Review Committee, Medical & Scientific Advisory Board, nor Foundation staff and officials endorse any treatments or products reported here. All issues pertaining to the care and treatment of patients with ichthyosis should be discussed with a dermatologist experienced in the treatment of this complex disease.