Clive Anderson - AT THE DERMATOLOGIST READERS' FEEDBACK
I am having a terrible problem with my skin and I am hoping that you can help me too. My skin is what could be described as scaly skin. It's dry and wrinkled. I have used all sort of moisturising lotion but none of them seem to really iron out my wrinkled skin. I even started using olive oil, but to no avail. I am back to square one trying to find another lotion. I am presently taking Vitamins E & A, because I do not eat a lot of vegetables and fruits on a daily basis. Please can you give me some advice as to how to treat this problem? Thanks for your help in advance.
DERMATOLOGIST'S RESPONSE
This query from a reader is an opportunity to address a very common condition. The dry, scaly skin this patient describes is characteristic of a condition called Ichthyosis. The term ichthyosis is from the Greek root - "ichhys" meaning fish. The skin of some of these patients resembles the scales of fish.
The mechanisms involved in this skin disorder are unclear but it may be that there is a disorder in the production of lipids or fats in the skin. Normally, the body constantly renews the surface of the skin replacing the older cells with new skin cells. The older cells fall from the surface of the skin constantly and we all go around shedding skin cells constantly.
Ichthyosis disrupts this balance either because too many new cells are produced or because the cells do not fall off when they are supposed to. The result is that the cells accumulate on the surface of the skin as thick flakes often resembling fish scales.
Ichthyosis ranges from mild dryness of the skin to severe dryness with scales and flaking. It is not a contagious disease. The mildest form is called xerosis and occurs most frequently on the lower limbs of older persons. There may be mild to moderate itching often associated with bathing with harsh soaps.
Inherited ichthyosis is first evident in early childhood appearing usually during the first year and in the majority by age five. This is the most common form of the condition accounting for more than 95 per cent of cases. Some studies put the incidence of this condition among school children as high as one in 250. The scaling usually intensifies up until puberty and then may decrease with age. The dry, scaly skin is often very itchy.
The scaling is usually more severe on the legs with thick, dark overlapping scales on the shin. The face is generally spared due to the secretion of sebum. There is often fine scaling of the scalp. An unusual body odour may exist as the spaces between the skin flakes can harbour bacteria and fungi. Many of these patients have associated atopic manifestations of asthma, hay fever and eczema.
Acquired ichthyosis is similar in every way to the inherited version but appears for the first time in adult years. This type of ichthyosis is associated with many diseases like nutritional disorders, thyroid disease, kidney diseases and certain cancers.
A doctor can usually diagnose Ichthyosis by looking at the skin. The treatment of this condition involves restoring the skin's moisture and encouraging the shedding of the dead skin cells. Moisturisers are the mainstay of treatment. Plain petrolatum, mineral oil, creams/lotions with the alpha glycolic acids or urea is often used. The greaser the moisturiser, the better for the skin. Several products do a good job if applied frequently.
These include Cetaphil cream & lotion, Neutrogena Norwegian formula, Aveeno moisturisers, E45 cream, Keri lotion (original) & Emulsifying ointment to name a few. To get the best results apply the moisturisers after a bath in order to trap water in the skin. Apply frequently during the day eight to 10 times. Other useful agents include salicylic acid preparations that promote the shedding of cells. Air conditioning can be very drying to the skin. If body odour is a problem, antibiotics and antifungal treatment may be necessary.
To the reader, a consultation with your Dermatologist will allow for more detailed recommendations suited to your skin.
Dr. Clive Anderson is a Dermatologist and Venerologist.
