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Something’s fishy

Understanding icthyosis or scaly skin

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By Dr. Kaycee Reyes

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Time and time again, we have been constantly reminded by our mothers, our friends, our doctors, and even the media, to moisturize, moisturize, moisturize. And why not? The skin needs to be hydrated and healthy at all times to perform its main functions properly: to regulate the body’s temperature, to protect the body’s internal organs from chemicals and external microorganisms, and let the body feel the changes in the environment through touch and sensation. But what if the skin is constantly dry, flaky, and scaly for long periods of time, similar to a condition called icthyosis? Will it affect its proper function? Will it lead to other serious complications?

Icthyosis comes from the Greek words itchy, which means fish, and–osis, meaning disease. It is described as constant scaling of the skin. It is a rare skin disorder that commonly appears at birth, or along the course of a year after birth, and is carried on through the individual’s lifetime. Other times, it is acquired as a complication of another illness such as HIV, kidney disease, cancer, thyroid problems, or other serious illnesses; in which case, icthyosis may happen at any age. Either way, icthyosis has no cure, and it can range from mild to severe.

Icthyosis vulgaris is the most common type of this skin disorder. It has been found that the cause of this is the gene defect passed on to offspring, specifically the protein that controls the skin’s moisture and balance. It may manifest as rough scaling on the arms and legs, sometimes including the palms and soles too. This type of icthyosis may worsen or improve with the weather, but it gradually becomes better and more manageable over time. This has a 50 percent chance of being passed on to the offspring. Regular application of moisturizers is enough to manage this type of condition. X-linked icthyosis, on the other hand, only affects the males. Usually, the mother, who may not manifest the condition, may have a 50 percent chance to pass on the gene to her offspring. X-linked icthyosis are gray and scaly areas spread across the arms and legs, the trunk, and may even affect the face. Like icthyosis vulgaris, this may have some improvement in warm weather, but its severity usually stays the same throughout the individual’s lifetime. For the more severe cases acquired at birth (passed genetically), there is the non-bullous congenital icthyosiform erythroderma. At birth, a shiny film covers the newborn, called colloidal membrane, and eventually sheds off. Some babies have normal skin after shedding, while most develop non-bullous congenital icthyosiform erythroderma or red, scaly skin without blisters. Sometimes, those who have it also have outward turning eyelids and lips, and abnormal nail growth. While the baby may grow up healthy, except for the condition, the problem may arise when the child gets older, as it may affect his or her quality of life. Another severe case acquired at birth is lamellar icthyosis, which is similar to congenital icthyosiform erythoderma, where a colloidal membrane envelops the baby. But it differs, such that there is less inflammation, but more scaling of the skin. Harlequin icthyosis may probably be the most severe but also the rarest among the types, where the scaling is very thick and requires immediate and careful attention. Bullous congenital icthyosiform erythroderma (red scaly skin with blisters) is also possible among newborns, and because of the blistering and skin’s sensitivity, this may also require intensive care for the baby.

Some who have icthyosis improve their symptoms through the years; others do not.  Unfortunately, there is no cure for it. But depending on the type of icthyosis acquired, there are ways to manage them. For those with acquired icthyosis or mild icthyosis, moisturizers, lotions, and creams may help significantly. For the more severe types, oral medication, such as synthetic retinoids, may be prescribed as it can lessen the dryness and flakiness of the skin. But retinoids must be carefully administered as it can negatively affect an unborn baby. More than medication, family support or regular counseling is crucial for individuals who have this skin condition, as their appearance may affect their overall wellbeing, too. Constant reassurance and support are needed so the child will understand the situation and accept it better. More research is needed for icthyosis and, with hope, in the future, a cure may come around.

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