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Abstract: Ichthyosis vulgaris is a common genetic skin disease that often develops after birth, and most cases are mild and often present with dry skin. Patients with common ichthyosis should have the awareness to apply moisturizing cream for a long time, and take oral vitamin E, or vitamin A capsules if necessary. This patient has been suffering from the disease for more than 30 years, and the dryness and pruritus symptoms were significantly aggravated. After being treated with oral + topical medication, the rash and pruritus symptoms improved significantly.
Basic information】Female, 40 years old
Disease Type】Unusual Ichthyosis
Hospital】The First Affiliated Hospital of Anhui Medical University
Time】May 10, 2022
Treatment plan】Medication (vitamin E cream, vitamin A acid cream, moistening and anti-itching capsule)
Treatment Period】14 days of outpatient treatment, outpatient follow-up
Effectiveness】Significant relief of dry skin and flaking
I. Initial consultation
The patient is a 40-year-old female with a skin rash with pruritus on both lower extremities for more than 30 years. The patient’s rash occurred since childhood, with heavy rash in winter and light rash in summer, accompanied by mild itchiness, and she usually applied moisturizing cream by herself. Physical examination: light brown or dark brown rhombic or polygonal scales were found on both lower limbs, the scales were fixed in the center and slightly raised at the periphery, like fish scales, covered with scattered fine flaky white bran-like scales, and the patient complained of obvious pruritus. Based on the patient’s typical clinical manifestations and medical history, the diagnosis of common type ichthyosis was clear. The patient’s father and sister had similar rashes on both lower extremities, denied history of other diseases such as hypertension and diabetes mellitus, denied history of drug allergy, denied bad habits such as smoking and alcohol.
II. Treatment history
The patient had a history of more than 30 years and had not paid attention to it before. The patient asked whether there was any possibility of malignant change, and was told that common ichthyosis is a hereditary skin disease with a high incidence in the population and no tendency of malignant change. At present, oral retinoic acid medication and topical medication can be used for treatment, and it is necessary to take good care of the skin on a daily basis. Considering that oral retinoic acid drugs may lead to dry mouth, elevated blood lipids and other adverse reactions, and that the patient’s rash is not heavy at present, the patient should be treated with Chinese medicine, topical creams and moisturizing creams that have few safe side effects. The patient was treated with topical vitamin E cream and retinoic acid cream, and oral moisturizing and anti-itching capsules for 14 days, and at the same time, skin care was strengthened with high-dose body lotion, avoiding hot water bathing and excessive scratching.
III. Treatment effect
After 14 days of treatment, the patient visited the clinic again. The scales on both lower limbs were significantly reduced, the skin was smoother than before, and the color of fish scale and irregular brown rash had become lighter. Patient’s self-report: the pruritus was reduced, he was satisfied with the treatment effect and was willing to continue the treatment. On the treatment plan, the use of moistening and anti-itching capsules was discontinued, the topical application of vitamin E cream and vitamin A cream continued, and the body lotion continued to be used. Because the disease is hereditary and cannot be cured, the patient needs to use body lotion for a long time to improve the symptoms.
IV. Precautions
I am glad that the patient’s itching symptoms are reduced after treatment, but the patient should pay attention to the diet during treatment, avoiding spicy and stimulating foods, eating more vegetables and fruits, and taking more vitamin A-rich foods, such as carrots and animal liver. When patients take a bath, do not use soap, bathing milk, bath water temperature is appropriate, should not be too hot, the frequency of bathing should not be too frequent, do not use bath towels rubbing bath, usually to strengthen the skin moisturizing, avoid excessive scratching.
V. Personal insight
Common ichthyosis is a common hereditary skin disease with a high prevalence in the population. Since most of the patients do not have obvious symptoms, they do not have a strong will to consult the doctor, and the disease cannot be cured, so the treatment is mainly symptomatic. Common type ichthyosis is generally characterized by dry skin, fish scale like light brown patches and hyperkeratosis. Treatment is based on moisturizing and exfoliating. Patients with obvious systemic symptoms can take oral retinoids and Chinese herbal medicines to relieve symptoms. In the case of this patient, the rash is mild and can be treated without vitamin A acid drugs. Topical medications can be chosen from vitamin E cream, retinoic acid cream, compound dexamethasone acetate cream, etc. Pay attention to local daily care, enhance moisturizing and avoid stimulating the skin.