Medication Selector
Compare all treatments for every ichthyosis type. Filter by your type, see efficacy data, costs, and side effects — then talk to your dermatologist.
19 medications shown
| Drug / Treatment | Works for | Category | Efficacy | NHS Cost | Timeline | Evidence | Side Effects | |
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50:50 White Soft Paraffin / Liquid Paraffin Emollient — Barrier |
VulgarisX-LinkedLamellarHarlequinNethertonKID | Emollient | NHS: Free £3–5 / 500g |
Days–weeks | RCT |
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MechanismOcclusive barrier reduces transepidermal water loss (TEWL). Softens scale and reduces friction. DosingApply liberally 2–4× daily, especially after bathing. Use large quantities (500g/week typical for severe cases). MonitoringNo monitoring required. Check for skin infection signs. NotesFirst-line treatment for all ichthyosis types. FLAMMABLE — keep away from flames and cigarettes. Wash clothing frequently. | ||||||||
Urea 10–40% Cream Emollient — Keratolytic |
VulgarisX-LinkedLamellarHarlequin | Emollient | NHS: Free £8–15 / 100g |
2–4 weeks | RCT |
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MechanismUrea disrupts hydrogen bonding in keratin, softening and dissolving scale. Higher concentrations (30–40%) are more keratolytic. Dosing10% for maintenance moisturising; 30–40% for thick scale reduction. Apply 1–2× daily. Avoid open wounds. MonitoringNo blood monitoring. Watch for skin irritation. Start with lower concentration. NotesHighly effective keratolytic. Particularly useful on palms/soles. Can sting on fissured skin — dilute or switch to lower % if needed. | ||||||||
Lactic Acid 5–12% Lotion Topical — Alpha-hydroxy acid |
VulgarisX-LinkedLamellarBathing Suit | Topical | NHS: Free £10–20 / 200ml |
2–6 weeks | Review |
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MechanismAHA breaks down corneocyte cohesion, promoting scale shedding. Also increases water binding in stratum corneum. DosingApply to damp skin after bath/shower. Use 5% initially, increase to 12% if tolerated. Once or twice daily. MonitoringNo blood tests. Apply sunscreen when using — photosensitising. Avoid eye area. NotesGood for body areas with thick scale. Amlactin (12%) and CeraVe SA are well-tolerated OTC options. Not for face or genital area. | ||||||||
Tazarotene Cream 0.05–0.1% Topical Retinoid |
VulgarisX-LinkedLamellar | Topical | Off-label £40–80 / tube |
4–8 weeks | Case series |
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MechanismBinds RAR-β and RAR-γ receptors, normalising keratinocyte differentiation and reducing hyperkeratosis. DosingApply thin layer to affected areas once daily (evening). Start with 0.05%, increase if tolerated. MonitoringContraindicated in pregnancy/breastfeeding. Negative pregnancy test required before start. No blood monitoring. NotesMore potent than tretinoin topically. Use sunscreen. Do not apply to face or genitals. Wrap method improves penetration on thick scale. | ||||||||
Acitretin (Neotigason) Systemic Retinoid — Oral |
LamellarHarlequinNethertonKIDBathing Suit | Systemic | NHS: Free £120–200/mo |
4–12 weeks | RCT |
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MechanismBinds retinoic acid receptors, normalising keratinocyte proliferation and differentiation. Reduces scale thickness and turnover rate. DosingStarting dose: 0.3–0.5 mg/kg/day. Maintenance: lowest effective dose (often 10–25mg/day). Take with food (fat improves absorption). MonitoringLFTs + lipids at baseline, 4 weeks, 8 weeks, then every 3 months. Avoid vitamin A supplements. X-Plan (Pregnancy Prevention Programme) mandatory in women of childbearing potential. NotesGold-standard systemic for severe ichthyosis. Teratogenic for 3 years after stopping — critical counselling needed. Most effective for lamellar and harlequin types. | ||||||||
Isotretinoin (Roaccutane) Systemic Retinoid — Oral |
LamellarHarlequinBathing Suit | Systemic | Off-label £80–150/mo |
4–12 weeks | Case series |
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MechanismSimilar to acitretin — normalises keratinocyte differentiation. Shorter teratogenic window (1 month vs 3 years for acitretin). DosingOff-label for ichthyosis. Dose: 0.3–0.5 mg/kg/day. Often used when acitretin not tolerated. MonitoringLFTs, lipids, pregnancy test (iPLEDGE or equivalent). 1-month washout for contraception after stopping. NotesPreferred over acitretin in women of childbearing age due to shorter teratogenic period. Similar efficacy but less evidence for ichthyosis specifically. | ||||||||
Dupilumab (Dupixent) Biologic — IL-4/IL-13 inhibitor |
NethertonHarlequin | Biologic | Compassionate £8,000–14,000/yr |
4–16 weeks | Case reports |
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MechanismMonoclonal antibody blocking IL-4Rα, inhibiting IL-4 and IL-13 signalling. Reduces Th2-driven inflammation. Particularly relevant in Netherton (SPINK5 defect drives Th2 skewing). Dosing300mg SC every 2 weeks (after loading dose). Self-injectable pen. Prescribed off-label via compassionate use or MDT decision. MonitoringRegular dermatology review. No specific blood tests required but ophthalmology if conjunctivitis develops. NotesGrowing evidence in Netherton syndrome. Case reports show dramatic improvement in itch, scaling, and skin infections. May become standard of care. Currently requires specialist application for NHS funding. | ||||||||
Secukinumab (Cosentyx) Biologic — IL-17A inhibitor |
NethertonKID | Biologic | Compassionate £9,000–12,000/yr |
8–24 weeks | Case reports |
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MechanismSelectively inhibits IL-17A, reducing neutrophil recruitment and keratinocyte activation. May normalise abnormal differentiation. Dosing300mg SC weekly × 5 doses, then monthly. Dermatology specialist only. MonitoringScreen for TB before starting. Monitor for signs of IBD. Regular dermatology follow-up. NotesLimited but positive evidence in Netherton syndrome. Off-label use. Caution in IBD history. | ||||||||
Low-dose Antibiotics (Flucloxacillin / Erythromycin) Prophylactic Antimicrobial |
NethertonKIDHarlequin | Systemic | NHS: Free £10–20/mo |
Weeks (prophylaxis) | Review |
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MechanismReduces recurrent Staphylococcus aureus skin colonisation, which exacerbates inflammation and barrier dysfunction in Netherton and KID syndrome. DosingFlucloxacillin 250mg twice daily (long-term prophylaxis). Erythromycin as alternative if penicillin-allergic. MonitoringRegular review to assess ongoing need. Annual culture if recurrent infections. Monitor for resistance patterns. NotesUsed prophylactically to prevent recurrent skin infections, not treat acute episodes. Discuss antibiotic stewardship with specialist. | ||||||||
Phytanic Acid-Restricted Diet Dietary Intervention |
Refsum Disease | Systemic | NHS: Dietitian Dietary cost |
Months–years | Review |
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MechanismPHYH enzyme deficiency impairs phytanic acid oxidation. Dietary restriction reduces phytanic acid accumulation, preventing further neurological and dermatological damage. DosingRestrict dairy fat, ruminant meats, certain fish. Target serum phytanic acid <200 μmol/L. Supervised by metabolic dietitian. MonitoringRegular serum phytanic acid levels (3–6 monthly). Nerve conduction studies. Ophthalmology for retinitis pigmentosa. Annual cardiac echo. NotesPRIMARY treatment for Refsum disease. Must be maintained lifelong. Plasmapheresis used in acute crises or to rapidly reduce phytanic acid. Co-manage with metabolic specialist and neurologist. | ||||||||
Plasmapheresis Extracorporeal Procedure |
Refsum Disease | Systemic | NHS: Hospital £1,500–3,000/session |
Days (acute) | Review |
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MechanismRemoves phytanic acid directly from plasma. Used when dietary restriction is insufficient or during acute exacerbations. Also used perioperatively. DosingSchedule determined by metabolic specialist. Series of sessions to reduce phytanic acid burden. Maintenance sessions ongoing if diet alone insufficient. MonitoringPre- and post-session phytanic acid levels. Coagulation, albumin, calcium. Specialist centre required. NotesAdjunct to dietary restriction, not a replacement. Used for acute worsening or to rapidly lower levels before surgery. Specialist centres only. | ||||||||
Ciclosporin (Cyclosporine) Systemic Immunosuppressant |
NethertonHarlequin | Systemic | NHS (specialist) £200–400/mo |
4–8 weeks | Case series |
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MechanismCalcineurin inhibitor — blocks T-cell activation. Reduces inflammatory cascade driving skin inflammation in Netherton syndrome. Dosing2.5–5 mg/kg/day in 2 divided doses. Short-term courses preferred. Maximum 1–2 years continuous use. MonitoringBP every 2 weeks initially. Renal function (creatinine), LFTs, FBC at baseline then monthly. Avoid nephrotoxic drugs. NotesUsually short-term bridge while other treatments initiate. Long-term risk of nephrotoxicity and malignancy limits use. Significant drug interactions — check all medications. | ||||||||
Tacrolimus 0.03–0.1% Ointment (Protopic) Topical Calcineurin Inhibitor |
NethertonVulgaris | Topical | NHS: Free £25–50 / 60g |
2–6 weeks | Review |
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MechanismInhibits calcineurin → blocks T-cell activation → reduces inflammatory cytokines at skin level. Steroid-free immunosuppression. DosingThin layer to affected areas twice daily. 0.03% for children ≥2 years; 0.1% for adults. Reduce to once daily or twice weekly when controlled. MonitoringNo blood tests. Avoid prolonged use on large areas or under occlusion. Use sunscreen — theoretical photosensitivity concern. NotesUseful for face and flexures where steroids are undesirable. Caution in active skin infection. MHRA advises against continuous long-term use — pulse therapy preferred. | ||||||||
Topical Lovastatin + Cholesterol (2% / 2%) Topical Statin — CHILD Syndrome specific |
CHILD Syndrome | Topical | Compounded only £80–200/month |
8–24 weeks | Case reports |
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MechanismCHILD syndrome caused by NSDHL deficiency in cholesterol biosynthesis pathway. Topical statin + cholesterol corrects the local metabolic defect in affected skin. DosingCompounded 2% lovastatin + 2% cholesterol in petrolatum. Apply twice daily to affected (unilateral) areas. Compounding pharmacy required. MonitoringNo specific monitoring. Clinical photography to track response. Specialist dermatology follow-up. NotesDisease-specific treatment — only for CHILD syndrome. Remarkable case reports showing near-complete clearance. Must be compounded. Contact specialist centres (Great Ormond Street, etc.). | ||||||||
N-Acetylcysteine (NAC) Antioxidant / Mucolytic |
NethertonKIDLamellar | Systemic | Off-label / OTC £10–30/mo |
8–16 weeks | Case reports |
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MechanismPrecursor to glutathione. May reduce oxidative stress in skin. Some evidence for improving ichthyosis severity, but weak evidence base. Dosing600mg twice daily (oral) as adjunct. Also available as effervescent tablets (used for respiratory conditions, repurposed here). MonitoringNo specific monitoring. Generally well-tolerated. Take with food to reduce GI effects. NotesLimited evidence but low risk. May be worth trying as adjunct in severe cases. Discuss with dermatologist. Available OTC but discuss with specialist before starting. | ||||||||
Oilatum / Balneum Bath Additives Emollient — Bath Additive |
VulgarisX-LinkedLamellarHarlequin | Emollient | NHS: Free £5–12 |
Days | Review |
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MechanismOil dispersed in bath water coats skin, reducing water loss after bathing. Helps rehydrate and soften scale before applying leave-on emollients. DosingAdd recommended amount to warm (not hot) bath. Soak 10–20 minutes. Pat dry gently, apply emollient immediately while skin still damp. MonitoringNon-slip mat essential — oil makes baths very slippery. No medical monitoring. NotesUseful adjunct to daily routine. Works best combined with leave-on emollients applied immediately post-bath. Balneum Plus contains lauromacrogol for antipruritic effect. | ||||||||
Calcipotriol (Dovonex) 0.005% Topical Vitamin D Analogue |
LamellarVulgarisX-Linked | Topical | NHS: Free £15–30 / 60g |
4–8 weeks | Case series |
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MechanismVitamin D analogue that modulates keratinocyte differentiation via VDR receptor. Reduces hyperproliferation. Limited evidence base for ichthyosis. DosingApply thin layer to affected areas once or twice daily. Maximum 100g/week to avoid systemic hypercalcaemia. Not for face/genitals. MonitoringCalcium monitoring if using large areas or long-term. No other specific monitoring. NotesLimited ichthyosis-specific evidence. More commonly used for psoriasis. May be worth trying for scale reduction as adjunct. Combine with emollient. | ||||||||
Ruxolitinib / Baricitinib (JAK inhibitors) Systemic — JAK Inhibitor |
NethertonKID | Systemic | Compassionate £8,000–15,000/yr |
4–12 weeks | Case reports |
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MechanismJAK1/2 inhibitors block cytokine signalling driving inflammatory ichthyosis. Particularly relevant for GJB2-associated KID syndrome with dysregulated EGFR/JAK signalling. DosingOff-label dosing — specialist only. Ruxolitinib 5–20mg twice daily oral; baricitinib 2–4mg once daily. MonitoringFBC, lipids, LFTs, renal function at baseline, 4 weeks, then 3-monthly. Herpes zoster prophylaxis consider. MACE and VTE risk screening. NotesEmerging evidence in ichthyosis. Black box warning for serious infections, malignancy, and cardiovascular events. Specialist MDT decision required. Tofacitinib also reported in case studies. | ||||||||
Udrate Cream (Urea 10% + Lactic Acid 5%) Emollient — Keratolytic Combination |
VulgarisX-LinkedLamellarHarlequinNetherton | Topical | NHS: Free £8–14 / 100g |
2–4 weeks | RCT |
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MechanismUrea hydrates the stratum corneum and at 10% acts as a keratolytic, loosening and softening scale. Lactic acid (5%) provides additional AHA exfoliation and moisture-binding via lactate in the NMF. Together they tackle both scale build-up and transepidermal water loss. Replaces CalmuridCalmurid (urea 10% + lactic acid 5%) was discontinued in the UK in 2023. Udrate contains the identical active formula and is considered a direct NHS substitute. GPs can prescribe Udrate on FP10; if unavailable, request urea 10%/lactic acid 5% cream as a specials formulation. DosingApply to affected areas once or twice daily after bathing while skin is still slightly damp. Avoid open wounds or actively inflamed skin — the lactic acid will sting. For very thick scale, apply under cling-film occlusion overnight to boost penetration. NotesOne of the highest-evidence topical keratolytic emollients for ichthyosis. Well tolerated for long-term daily use. Can be combined with a plain emollient base applied on top for extra moisture. Particularly effective for X-linked and lamellar ichthyosis where scale is dense and adherent. | ||||||||
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Understand your options before your appointment
Use this table to prepare questions for your dermatologist — not to self-prescribe.
All medications are prescription only
Even OTC products like emollients are best prescribed via GP for ichthyosis to ensure adequate quantities on NHS.
Systemic drugs need specialist supervision
Retinoids, biologics, and immunosuppressants require specialist initiation and ongoing monitoring. Never start without supervision.
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