Acquired ichthyosis (AI) is a rare condition with onset in adulthood that is usually associated with underlying disease. It is clinically similar to ichthyosis vulgaris, a benign hereditable disorder that manifests in childhood.

AI may be associated with underlying malignancies, infectious, inflammatory, or metabolic disorders, or with medications. The most common associated malignancy is Hodgkin disease. Other less frequent associations include multiple myeloma, cutaneous T-cell lymphoma and other lymphoproliferative disorders, leiomyosarcoma, Kaposi sarcoma, and carcinomas of the breast, lung, liver, and bladder. Skin changes are most often noted following the diagnosis of the malignancy.

AI is often seen in human immunodeficiency virus (HIV) infection, usually with a low CD4+ count, and not necessarily associated with malignancy. It has also been reported in the setting of active tuberculosis infection.

Acquired ichthyosis may be seen with chronic metabolic disturbances (malnutrition, malabsorption, renal failure, hyperparathyroidism, hypopituitarism, hypothyroidism, and diabetes). It also occurs on occasion with connective tissue disease (eg, systemic lupus and dermatomyositis) as well as with sarcoidosis, Hansen disease (leprosy), and post-bone marrow transplant.

Drug-induced acquired ichthyosis may be caused by cholesterol-lowering agents, isoniazid, acitretin, butyrophenones, dixyrazine, maprotiline, cimetidine, allopurinol, hydroxyurea, and clofazimine.

Coincident hair loss may occur, as may pruritus or a burning sensation. Symptoms usually improve in a warm, moist climate.

Disease severity may parallel the course of the associated disorder. Acquired ichthyosis often remits after treatment of underlying malignancy.