Case study: Ichthyosis


The case
This elderly man had a dry, scaly skin for as long as he could remember. His mother had the same condition.

They controlled the condition with the frequent application of emollients. However, there were times when he developed painful cracks in the skin which bled and led to problems of secondary infection requiring treatment with antibiotics.

What is the diagnosis and management? What are the differential diagnoses?

Diagnosis and management

This patient has ichthyosis (ichthyosis vulgaris). About 95 per cent of cases are inherited through an autosomal dominant gene. The condition affects one in 250 of the population. Any part of the body is affected.

Some patients complain of restricted movements, vision or hearing because of thickened skin. There is no cure.
Symptoms can be reduced by bathing and the application of emollients.

Possible different diagnoses

Reaction to certain medications such as hydroxyurea or nicotinic acid.

Differential diagnosis

Erythema nodosum.
Scar sarcoidosis.
Lupus pernio — large bluish, red and dusky purple  infiltrated nodules and plaque-like lesions on the nose, cheeks, ears and toes.
Maculopapular eruptions.

Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire

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