Ichthyosis Vulgaris, popularly known as fish scale disease, is a rare inherited skin disease. It was first described in 1771 in a patient named Edward Lambert. This patient with advanced skin lesions was defined as hedgehog man and the disease was seen in 3 generation families. It is an extremely rare disease in the community. Although some publications reported that it is seen in 1 in 250 patients, generally mild types are more common.
What is fish scale disease?
Although it is a genetically inherited disease, it can be seen in some cases without genetic transmission. The disease in this way is called acquired fish scale disease. In normal individuals, epidermis cells on the surface of the skin are constantly renewed; The skin surface is constantly renewed by shedding the dead epidermis cells formed. Dead skin cells on the skin of individuals with fish scale disease cannot be shed and disposed of. In this case, dead skin cells accumulate on the skin surface and form a thick, dry layer in patches. Because these layers of dead cells, formed in patches, look like fish scales, this disease is called fish scale disease.
What are the symptoms of fish scale disease?
Since fish scale disease is a skin disease, all symptoms are related to the skin. There is a scaly appearance on the scalp. There are thick layers of skin in the form of polygons all over the body. These layers are usually brown, but may also appear gray or white. The skin is severely thickened and dry. Itching may occur due to dryness. These patients also have sweating problems. Individuals with fish scale disease cannot sweat.
Typically, complaints of ichthyosis Vulgaris patients worsen during the winter months. Since the weather is cold and drier in winter, dryness, and itching of the skin increase. Patches originating from dry and hardened skin are usually seen on the elbows and lower legs. Generally, there are thick dark segments on the skin. In more severe patients, deep painful cracks develop on the soles of the feet and on the palms.
What are the causes of fish scale disease?
Fish scale disease can occur from birth as well as in the first few years of childhood. Typically it disappears in early childhood years. Some individuals may never experience symptoms again in their lifetime. In some individuals, symptoms may return in adulthood.
As with many skin diseases, genetic factors play an important role in the transition of fish scale disease. Genetic transmission of the disease occurs autosomal dominantly. This means it only takes one parent to have the mutated gene to pass the disease on to the child. The probability of this disease in children of autosomal dominant inheritance parents with fish scale disease is 100%.
In some rare cases, this disease may develop in individuals without genetic transmission. In conditions such as cancer, kidney failure, or thyroid diseases, İt can occur without the genetic mutation. There are also patients reported after taking certain medications. The disease is thought to begin with the spread and exacerbation of the inflammation initiated by these drugs in the skin.
Fish scale disease can also occur due to some skin diseases such as atopic dermatitis or keratosis pilaris. Atopic dermestid is a disease characterized by red itchy skin lesions, commonly known as eczema.
What are the types of fish scale disease?
Although the symptoms and clinical pictures of it, which is a genetically inherited disease, are similar, several types differ in terms of genetic transmission. Although the type with autosomal dominant inheritance is commonly seen, there is also a form that is carried depending on the Y chromosome. In this form, only boys get sick. Apart from the genetic transmission, there are also disease types acquired after some diseases.
How is fish scale disease diagnosed?
Dermatologists who specialize in skin diseases can diagnose this disease at first sight. The diagnosis is confirmed by questioning the family histories and anamnesis of the patients in childhood. Blood tests can be applied. Kein’s diagnosis is made by performing a biopsy from the lesions seen on the skin. Differential diagnosis is made especially between Psoriasis, or Psoriasis, which may have similar lesions. Skin biopsy distinguishes these two diseases.
What are the treatment methods for fish scale disease?
Currently, there is no definitive treatment for fish scale disease. However, treatments aimed at relieving symptoms are applied. This method of treatment is called antisymptomatic therapy.
Rubbing the skin lesions with a hard sponge or pumice stone after bathing can help exfoliate the dead tissue. Moisturizers containing urea or propylene glycol should be applied regularly and continuously. These chemicals help keep the skin moist. Using products such as urea, lactic acid, or salicylic acid can help shed dead skin cells.
Fish scale patients are recommended to use a humidifier at home all the time. Since dry air is the worst enemy of this disease, moisturizing the air that dries up in homes with heating especially during the winter months prevents the skin from drying.
Dermatologists also prescribe creams or medications to help moisturize the skin, get rid of dead skin and reduce skin inflammation and itching. Creams containing lactic acid and/or alpha hydroxy acid, which are also used in anti-aging cosmetics, are beneficial. In addition, Retinoids can be used to reduce the body’s skin cells. This substance is a derivative of vitamin A and has some side effects such as lip swelling or hair loss. It is not recommended to be taken during pregnancy.
What should be considered in fish scale disease?
In recent years, many studies have investigated the relationship of diet with skin diseases. Since some foods cause allergic reactions more frequently, they also cause an increase in skin lesions. Foods such as peanuts, milk, eggs, wheat, soy, fish, shellfish, sesame are considered to be the most allergenic foods. In addition to these foods, there may be specific allergen foods specific to the person. The individual noticing the foods that will increase the skin lesions and avoiding these foods provide relief in the long term. Apart from the importance given to nutrition, healing waters can soften skin lesions in fish scale disease. However, taking a bath with very hot water should be avoided. Avoid harsh soaps that dry the skin, and cleaning agents containing alcohol and perfumes. While drying the skin, it is more beneficial to pat the skin with soft touches instead of rubbing it with a towel. Moisturizing cream or lotions should be used after each bath. Individuals with fish scale disease should definitely increase the humidity of their environment with room humidifiers.
Living with fish scale disease is a very difficult process that significantly reduces an individual’s quality of life. In addition to the itching of the lesions, the difficulties of not being able to sweat, the difficulties of going out in sunny or cold weather, the appearance of skin lesions can cause cosmetic problems, especially in children. In such cases, getting help from both experts and social support groups is important in terms of gaining self-confidence and psychological support.
If you notice new similar lesions on your skin, do not neglect to make an appointment with a dermatologist immediately.
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