A Case of Ichthyosis Vulgaris and the Use of 70% Glycolic Acid Chemical Peels for Management

Ichthyosis vulgaris is the most common of the inherited ichthyoses, with a semi-autosomal dominance. Approximately 37-50% of people affected have associated atopic eczema and a similar proportion have atopic relatives. In this case report, we present a 15-year-old female with a history of atopic eczema who clinically presented with asymptomatic, brown, scaly patches on the extensor surfaces of the lower limbs and flexural surfaces of the upper limbs, sparing the flexural creases on all limbs. She also had neck, abdominal, and mild truncal involvement. A clinical diagnosis of ichthyosis vulgaris was made and the differential diagnoses of X-linked recessive ichthyosis, pityriasis rubra pilaris, and xerotic dermatitis were entertained. While waiting for the histological report, she was maintained on 5% glycerine in aqueous cream for daily moisturizing with alternating nightly applications of 10% glycolic acid lotion and a 5% salicylic acid mixture. The diagnosis of ichthyosis vulgaris was confirmed by histopathological findings of hyperkeratosis and an absent granular layer. She then received a 70% glycolic acid in-office chemical peel on the abdomen to test for the cosmetic outcome. The glycolic acid peel was approximately 90% efficacious in reducing the hyperkeratinization and is recommended as an adjunctive biannual maintenance regime in combination with other topical therapies such as daily emollients, topical alpha/beta hydroxy, and/or urea compounds.