ACQUIRED
ICHTHYOSIS
The development of ichthyosis in adulthood can be a manifestation of systemic disease and has been described in association with malignancies, drugs, endocrine and metabolic disease, human immunodeficiency virus (HIV) and other infections, and autoimmune conditions. The granular layer is often attenuated in this disorder, and the scale often resembles that seen in mild ichthyosis vulgaris. Although Hodgkin disease is the most common malignancy reported with acquired ichthyosis, non-Hodgkin lymphomas and a variety of other malignancies have also been observed.150 Skin involvement may follow the course of malignancy and clear with effective cancer treatment. Acquired ichthyosis is commonly seen in association with acquired immunodeficiency syndrome; ichthyotic or xerotic skin has been observed in up to 30 percent of acquired immunodeficiency syndrome patients A study of HIV-1-positive intravenous drug users found acquired ichthyosis occurred only after profound helper T-cell depletion, more frequently with co-infection with human T-cell leukemia/lymphoma virus type 2, and suggested that it may be a marker for concomitant infection with HIV-1 and human T-cell leukemia/lymphoma virus type 2.
In acquired ichthyosis occurring in association with sarcoidosis, skin biopsy can be diagnostic, showing noncaseating granulomas in the dermis Acquired ichthyosis may be a marker of autoimmune disease, occurring with systemic lupus erythematosus, dermatomyositis, mixed connective tissue disease, and eosinophilic fasciitis It has been described in bone marrow transplant recipients, where it may be related to graft-versus-host disease
Although occurrence in association with cholesterol-lowering agents (nicotinic
acid, triparanol) highlights the relationship between cholesterol metabolism and normal desquamation, acquired ichthyosis has been observed with a variety of drugs, including butyrophenone (antipsychotic), dixyrazine (major tranquilizer), and nafoxidine (estrogen antagonist). Kava is a psychoactive beverage made from the root of a pepper plant and used for thousands of years by Pacific Islanders. Heavy kava drinkers can acquire a reversible ichthyosiform eruption called Kava dermopathy. In Western nations, kava is sold in health food stores as a relaxant.
Confluent and Reticulated Papillomatosis of Gougerot and Carteaud
Confluent and reticulated papillomatosis of Gougerot and Carteaud is an uncommon but distinctive acquired ichthyosiform dermatosis seen in young adults and characterized by persistent brown, scaly macules, papules, patches, and plaques. Lesions tend to be localized predominantly on the neck, upper trunk (intermammary and interscapular regions), and axillae where they tend to be confluent and become reticulated towards the periphery . The lesions bear a clinical resemblance to tinea versicolor, a skin infection with Pityrosporum sp. A variety of treatment approaches have been reported, including topical (keratolytics, derivatives of vitamins A and D, antimicrobials) and systemic (antibiotics, retinoids) agents. Minocycline has been suggested as a first-line treatment; successful retreatment of recurrences supports the concept that this condition is an abnormal response to an infection or inflammation
