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James G. H. Dinulos

, MD, Geisel School of Medicine at Dartmouth

Last full review/revision May 2021| Content last modified May 2021
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Ichthyosis is scaling and flaking of the skin that ranges from mild but annoying dryness to severe and disfiguring skin disease.

(See also Itching and Dry Skin (Xeroderma).)

Ichthyosis is a form of severe dry skin. Ichthyosis causes scale to form on the skin in excessive amounts. Scale is areas of heaped-up, dead skin cells that appear as flaky, dry, rough patches.

Unlike xeroderma, which is ordinary dry skin, ichthyosis is dry skin that results from an inherited disorder (called inherited ichthyosis) or from a number of other disorders or drugs (called acquired ichthyosis).

Inherited ichthyoses

Inherited ichthyoses (the most common forms) are the result of genetic mutations that are usually passed on from parent to child but that sometimes occur spontaneously. Inherited ichthyoses are seen at birth or develop during infancy or childhood. There are many different types of inherited ichthyoses. Some affect only the skin, and others are just one part of inherited disorders that affect other organs.

Depending on the form, the scale may be fine or it may be large, thick, and warty. Scale may form on only the palms of the hands and soles of the feet, or it may cover most of the body. Some forms cause blisters, which may lead to bacterial infections.

Acquired ichthyoses

Acquired ichthyoses may be caused by a number of internal disorders, such as an underactive thyroid gland (hypothyroidism), lymphoma, and AIDS. Some drugs can cause acquired ichthyosis (such as nicotinic acid, triparanol, and butyrophenones). Acquired ichthyoses typically develop during adulthood.

Diagnosis of Ichthyosis

  • Development of characteristic scales

  • For inherited ichthyoses, tests and consultation with a geneticist

  • For acquired ichthyoses, sometimes skin biopsy

Inherited ichthyoses are diagnosed when infants are born with or children develop the characteristic scales on their skin. Doctors do tests and consult experts in genetics (geneticists) to determine the cause of inherited ichthyoses.

Acquired ichthyoses are diagnosed when people develop the characteristic scales after taking a drug or developing an internal disorder. Doctors may do a skin biopsy, which can sometimes determine an internal cause.

Treatment of Ichthyosis

  • Moisturizers

  • For acquired ichthyoses, treatment of cause

  • For inherited ichthyosis, vitamin A–related prescription drugs

  • For possible infection, antibiotics

For acquired ichthyosis, the underlying disorder is treated or the drug causing the ichthyosis is stopped. Other treatments include keeping the skin moist with moisturizers and avoiding having the skin dry out.

Moisturizers containing petroleum jelly, mineral oil, salicylic or lactic acid, ammonium lactate, ceramides, or urea should be applied immediately after bathing while the skin is still wet. Excess moisturizer can be removed by blotting with a towel.

To help remove the scales, adults can apply a solution of propylene glycol in water to the affected areas after bathing. The areas are then covered with a thin plastic film or bag overnight. The solution can be applied to children twice a day, but no film is used.

For inherited ichthyosis, creams or pills containing substances related to vitamin A, such as the retinoid tretinoin, oral isotretinoin, or oral acitretin, help the skin shed the excessive scales.

People who are at risk of bacterial infection may be given antibiotics by mouth.

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Psoriasis is a common chronic disease affecting 1 to 5% of the population worldwide. It causes distinctive raised, red patches with silvery scales. A border between the patch and normal skin is known as “psoriatic plaque.”  Which of the following is the reason these patches of plaque form?
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