Inflammatory

Medically reviewed by Dr. A.M. van Coevorden, dermatologist, on 5 October 2026

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Ichthyosisinherited dry, scaly skin

Ichthyosis is a group of inherited skin conditions with extremely dry, scaly skin that looks like fish scales. The most common form, ichthyosis vulgaris, is mild and easy to manage with rich moisturisers.

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What is ichthyosis?

Ichthyosis is a group of congenital skin conditions in which the skin is abnormally dry and scaly. The name comes from the Greek word ichthys, meaning fish: the rough, scaly skin resembles fish scales. Hence the everyday names fish scale skin and fish skin disease.

There are four main types:

Ichthyosis vulgaris

The most common and mildest type. The skin lacks the protein filaggrin, so the outer layer does not form normally. Affects about 1 in 250 people.

X-linked ichthyosis

Only in boys and men. The enzyme steroid sulphatase is missing. Causes brown scales, especially on the neck.

Lamellar ichthyosis

A rare, more severe type. Babies are sometimes born with a tight membrane over the skin (collodion baby). Later, dark brown scales over the whole body, including the face.

Congenital bullous ichthyosiform erythroderma

Rare. A defect in the protein keratin. Red skin with blisters at birth; the tendency to blister decreases over the years.

Is ichthyosis hereditary?

Yes. In ichthyosis the genes that regulate the balance between producing new skin cells and shedding old ones are faulty. Ichthyosis vulgaris is inherited in an autosomal dominant way: if one of your parents has it, each child has about a 50 percent chance of having it too. X-linked ichthyosis is passed from mother to son. Some forms of lamellar ichthyosis are inherited recessively: both parents carry the gene without having symptoms themselves.

Ichthyosis symptoms: what does fish scale skin look like?

In ichthyosis vulgaris the skin is normal at birth. Symptoms usually start between 2 and 6 months of age. You see fine white to grey scales on the trunk, the arms and especially the lower legs. The skin folds, such as the inside of the elbows and the backs of the knees, stay clear. The palms and soles can be thickened with cracks and unusually deep hand lines. The skin is worse in winter and better in summer.

Ichthyosis vulgaris often goes together with atopic eczema, asthma and hay fever, and with keratosis pilaris: rough bumps on the upper arms and thighs. Plain dry skin without these features is usually not ichthyosis.

Is ichthyosis contagious?

No. Ichthyosis is hereditary and not contagious. You cannot catch it from someone else or pass it on, except through your genes to your children.

How does the dermatologist make the diagnosis?

The dermatologist usually recognises ichthyosis from the look of the skin, combined with questions about your family: is dry, scaly skin common among your parents, brothers or sisters? Sometimes further tests are needed: for X-linked ichthyosis a blood test for the enzyme steroid sulphatase, for other types a skin biopsy or DNA testing. At 247dermatologist you send photos of your lower legs, arms and palms and answer questions about your family and your symptoms. Within 12 to 48 hours the dermatologist assesses whether the picture fits ichthyosis and which skin care suits your skin.

Ichthyosis treatment: what helps?

Ichthyosis cannot be cured, but the skin can be managed well. The basis is moisturising every day.

Rich moisturisers

A rich, emollient cream or ointment every day keeps the skin supple and reduces scaling.

Urea cream

Creams containing urea hold moisture and thin the thickened outer layer, so the scales loosen.

Bath oil

An emulsifying bath oil in the bath or shower makes the skin less dry.

With eczema

If atopic eczema develops as well, the dermatologist prescribes a corticosteroid cream to calm the itch and inflammation.

Severe types

X-linked and lamellar ichthyosis are sometimes treated with acitretin, a tablet derived from vitamin A. This is always done under the supervision of a dermatologist.

Does ichthyosis go away?

The signs of ichthyosis remain for life. Ichthyosis vulgaris becomes milder after puberty in about half of people. X-linked ichthyosis can also improve slightly with age. Lamellar ichthyosis usually does not improve. With good daily skin care, most people keep their symptoms well under control.

What can you do yourself about ichthyosis?

Daily skin care is in your own hands:

apply a rich moisturiser every day, more in winter
use as little soap as possible
do not shower or bathe too hot or too long
use a bath oil instead of soap or shower gel
moisturise straight after showering, while the skin is still damp

When to see a dermatologist or GP?

Have your skin assessed if:

your skin keeps scaling or cracking despite daily moisturising
red, itchy eczema patches appear
sores, crusts or inflamed areas develop
your child has noticeably dry, scaly skin and you want to know what it is
you want to know which cream suits your skin best

A baby born with red skin, blisters or a tight membrane over the skin is assessed in hospital straight away. For all other questions about dry, scaly skin, a dermatologist at 247dermatologist assesses your photos within 12 to 48 hours, no referral needed, with skin care advice and a prescription where necessary.

Frequently asked questions about ichthyosis

Not sure whether this needs a look? Have a dermatologist assess it: you get an answer within 12 to 48 hours, no referral needed. In an emergency, contact your GP straight away or call 112.

What is fish scale skin?

Fish scale skin is the everyday name for ichthyosis: an inherited condition in which the skin is extremely dry and scales like fish scales. The name comes from the Greek word ichthys, fish.

Is ichthyosis vulgaris hereditary?

Yes. Ichthyosis vulgaris is inherited in an autosomal dominant way. If one of your parents has it, each child has about a 50 percent chance of having it too.

Which cream is best for ichthyosis?

A rich, emollient cream applied every day, and creams with urea to thin the thickened outer layer. Which cream suits you best depends on how dry and thick your skin is. The dermatologist advises you on that.

Is ichthyosis the same as dry skin?

No. Almost everyone has dry skin now and then, especially in winter. Ichthyosis is hereditary, starts in the first year of life, causes scales on the lower legs and arms that spare the skin folds, and often comes with eczema and keratosis pilaris.

Does ichthyosis go away as you get older?

Not completely, the tendency remains for life. Ichthyosis vulgaris does become milder after puberty in about half of people.

Can ichthyosis be cured?

No. Ichthyosis cannot be cured, but the skin can be managed well with daily moisturising, little soap and bath oil. Severe types can be treated with medicines under the supervision of a dermatologist.

Does eczema go with ichthyosis?

Often, yes. Ichthyosis vulgaris frequently goes together with atopic eczema, asthma and hay fever. The eczema is treated separately, usually with a corticosteroid cream.

Have a dermatologist look at your skin

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If more is needed, the dermatologist refers you to a medical specialist.

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Sources and more information

Source: Dutch Society of Dermatology and Venereology (NVDV) and huidziekten.nl.

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Ichthyosisinherited dry, scaly skin