Beware of Underlying Malignancy: Acquired Ichthyosis

Here, Word et al present their management of a 79-year-old Caucasian man diagnosed with acquired ichthyosis. Ultimately, the most important aspect of management of acquired ichthyosis is directed at resolving the underlying systemic process; in this patient's case, nodal anaplastic large cell lymphoma. For symptomatic relief, bathing, with gentle mechanical debridement and use of lubricating and hydrating creams and ointments, can facilitate in stabilizing the barrier function of the skin. Keratolytic agent preparations, such as lactic acid, salicylic acid, and urea, also can promote desquamation of hyperkeratotic scale, further promoting barrier function. Given the relapsing nature of our patient's CD30+ lymphoproliferative disorder, systemic chemotherapy was initiated. The patient underwent four cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone. After the second session, repeat positron emission tomography showed complete resolution of lymphadenopathy. Importantly, the ichthyotic eruption resolved at the same time. This resolution occurred even as the patient continued to lose weight due to side effects of chemotherapy, an important observation in ruling out malnutrition as a cause of his acquired ichthyosis.