Ichthyosis is a dry, peeling skin condition commonly known as lichen planus, which is a disorder of skin keratinization. Most people have dry skin with distinctive markings, rough to the touch, and often peeling or flaky skin that falls onto the sheets and looks like fish scale (or snakeskin) with white or brown fish scale scales. This disease is characterized by autumn and winter aggravation, late spring and summer to reduce or disappear lesions, most people have only the extremities, abdomen and back. A few serious cases can spread all over the body, even in summer.
1.What is the difference between different classifications of ichthyosis and the medication plan?
Ichthyosis is mostly a hereditary skin disease, and heredity is an important factor (about 70%), and there are many genes related to it, in addition, abnormal lipid metabolism, low vitamin A level and microcirculation disorder are also the causes.
However, there are also acquired ichthyosis, in which the skin will have ichthyosis-like changes after other diseases. Its clinical manifestations are similar to those of ichthyosis vulgaris, desiccation, and Rifaximin’s disease; they need to be analyzed and differentiated. However, if the cause is found and other diseases are eliminated, ichthyosis will also be eliminated or significantly improved.
Generally, there are four major types of congenital ichthyosis, depending on the symptoms described: the most common type is dominantly inherited ichthyosis vulgaris: this disease mostly starts to develop after 3 months to 5 years of age after birth. Generally, the skin is dry and covered with grayish white to light brown diamond-shaped or polygonal scales, often raised around the periphery, but close to the skin in the center; this kind of scaling occurs mostly on the extensor side of the limbs and the back. The majority of people may have peripapillary keratosis and palmoplantar keratosis on the extensor surfaces of the arms and extremities, and a few may also have skin allergies or rhinitis and asthma.
Less common types are sex-linked ichthyosis vulgaris, dominantly inherited congenital ichthyosis vulgaris and recessive congenital ichthyosis vulgaris infants, which tend to be more severe and may be combined with other organ problems.
Since there are different types of ichthyosis, different possible causes or triggers, different degrees of severity, and different treatment options, it is important to actively seek out possible causes or triggers. Generally, acquired ichthyosis may be cured as long as the triggering factors are eliminated, while congenital light ichthyosis may only require local application of medicine in the cold season of autumn and winter.
2.Is it necessary to use medication once ichthyosis is diagnosed, and can it be improved only by changing the lifestyle?
Ichthyosis is relatively easy to diagnose, and once diagnosed, it is not necessary to use medication immediately, it depends on the severity and seasonal situation.
3.What topical medications can be used to treat ichthyosis? What is the effect?
As the skin of ichthyosis is dry, strengthening moisturizing treatment can have obvious effect. External application such as urea ointment, salicylic acid ointment, 0.1% vitamin A acid cream or 20% cod liver oil ointment, medical petroleum jelly, can be effective in easing dry skin, flaking and cracking. Some people use keratolytic ointment such as 5%-6% salicylic acid ointment, 40%-60% propylene glycol aqueous solution, etc.. Or use water and alcohol gel of propylene glycol containing 6% salicylic acid, etc., and apply it for 4 to 8 hours, it is more effective for dominant hereditary common ichthyosis and sex-linked hereditary ichthyosis, but less effective for dominant hereditary congenital ichthyosis-like erythroderma and recessive hereditary congenital ichthyosis-like erythroderma, but 0.1% retinoic acid cream is effective for the latter two, but pay attention to the toxicity of salicylic acid and the high concentration of retinoic acid However, the toxicity of salicylic acid and the irritation of high concentration of retinoic acid should be noted.
The external treatment of Chinese medicine should be based on evidence: for blood deficiency and wind dryness, 60 g of almonds can be used in a decoction, then 90 g of walnuts and 10 g of milk can be pounded into a paste for external use; for blood stasis and obstruction, 15 g of rhubarb, 20 g of cinnamon stick and 30 g of peach kernel can be used in a decoction, then apply angelica paste (20 g of angelica, 50 g of sesame oil and 6 g of yellow wax, boil the sesame oil first, add angelica to the decoction until it is scorched, remove the residue and make it warm, then add yellow wax to form a paste) (from Journal of Practical Medicine and Technology, July 2007, Vol. 14, No. 21). July 2007, Vol. 14, No. 21, page 2909).
4.When do I need to treat with oral medication? Which drugs are not suitable for minors?
Generally, the mild or simple treatment should include oral vitamin A or vitamin E capsules, the former 5,000 to 10,000 u per time, twice a day; or trace elements supplementation. Only in the case of large areas, severe desquamation, easy to appear a lot of keratin loss, thick skin flakes, or erythroderma, oral treatment with retinoids such as retinoic acid, Avastin or vitamin A, such as vitamin A acid, 1mg/kg/day. However, long-term use may result in bone decalcification, hair loss and other toxic symptoms, and should be taken under the supervision of a physician. However, retinoids are not suitable for children under 16 years of age and may affect growth and development, unless the benefits outweigh the disadvantages.
You can also take Chinese medicine according to Chinese medicine diagnosis and treatment, such as taking ten whole tonic pills with cangzhi cream and blood province and silt oral liquid, etc. Some Chinese medicine additions can significantly improve or cure ichthyosis.
5.When can I stop taking the medicine? What is the effect of not taking medication according to the treatment schedule?
After the application of internal medicine for ichthyosis, the dosage can be slowly reduced and finally stopped, but attention should be paid to moisturizing and emolliency, otherwise it is easy to relapse or rebound. Treatment must be carried out reasonably under the guidance of doctors, gradually increase or decrease the dosage, do not take or stop the medicine at will, otherwise, not only no curative effect, or easy to tolerate affect the effect.
6.Is ichthyosis prone to recurrence, and what season is it prone to recurrence? Is the same treatment plan still used after recurrence?
Because ichthyosis is strongly influenced by heredity, it is easy to recur, especially in cold seasons such as early spring, late autumn and winter. Or in particularly dry seasons or areas. Generally, relapse can be treated by applying the original program, especially the moisturizing treatment.
7.Do I need to use hormones to treat ichthyosis? Is there any physical therapy applicable to ichthyosis treatment?
In general, hormone therapy is not recommended for ichthyosis, whether it is for external or internal use, there are many other alternatives to treat it. There are many physical therapy modalities available to help alleviate or cure ichthyosis, such as hydrotherapy, which is an important complementary therapy. Warm water bath (36～37 ℃) has good calming, anti-itching and soothing effects, and the temperature of 38～40 ℃ can make the skin congested, which can improve the blood circulation of the skin and play the role of promoting infiltration and absorption. Mineral bath therapy, through the role of trace elements in mineral springs can significantly improve the dryness and roughness of the skin, can quickly make the lesions scales off, and make the skin moist. The effect is even better when combined with light therapy, internal medication and moisturization.