Ichthyosis Vulgaris: Why Your Extremely Dry, Flaky Skin Won't Get Better (And What Actually Works)

If you're struggling with extremely dry, flaky and scaly skin that never seems to improve despite trying countless moisturisers and treatments, you might have a skin condition called Ichthyosis vulgaris. As someone who lived with undiagnosed Ichthyosis vulgaris for decades, I understand the frustration of being told "it's just dry skin".

What is Ichthyosis Vulgaris?

Ichthyosis vulgaris is a genetic dry skin condition that affects about 1 in 250 people. Despite being relatively common, it's frequently misdiagnosed as simple dry skin or eczema. It’s caused by mutations in the FLG gene, which is responsible for producing filaggrin—a protein essential for maintaining your skin's moisture barrier and normal cell turnover.

Ichthyosis (ick-thee-o-sis) comes from the Greek word ichthus which means fish, and vulgaris is the Latin word meaning ‘common’.

Filaggrin and Ichthyosis Vulgaris

Filaggrin is a crucial protein in your skin that acts like the mortar between bricks in a wall. When functioning properly, filaggrin:

• Helps your skin cells stick together properly
• Breaks down into natural moisturising factors (NMFs) that keep your skin hydrated
• Maintains your skin's protective barrier
• Helps maintain your skin's natural acidic pH

What Happens When Filaggrin Is Deficient

• Impaired skin barrier structure: Without enough filaggrin, skin cells don't properly connect and align, creating gaps in the protective barrier
• Reduced natural moisturisation: Lower levels of NMFs mean your skin cannot hold onto water moisture effectively
• Excessive water loss: The compromised barrier allows water to evaporate rapidly from the skin
• Abnormal cell turnover: Skin cells build up instead of shedding normally, creating visible scales
•  pH Changes and skin microbiome changes: The breakdown of filaggrin normally creates acidic compounds that maintain the skin's pH between 4.5-5.5. When filaggrin is deficient:
  • Skin pH becomes less acidic (more alkaline)
  • This altered pH creates an environment where harmful bacteria can thrive while beneficial bacteria decline
  • Bacteria like Staphylococcus aureus increase, which can trigger itching and skin inflammation
  • These skin microbiome changes significantly increase the risk of developing eczema (atopic dermatitis)

This combination of barrier disruption, water loss, and altered microbial balance is the reason why you experience dry, scaly skin and have a higher risk of developing inflammatory skin conditions like eczema.

Acquired Ichthyosis Vulgaris

While most cases of Ichthyosis vulgaris are genetic and the condition starts in childhood, it can be acquired due to health conditions and even medication later in life.

The most common health conditions that can cause Ichthyosis vulgaris are:

·        Thyroid disease

·        Hyperparathyroidism

·        Nutritional deficiencies – vitamin D, vitamin A and severe protein deficiency.

·        Chronic kidney failure

·        Autoimmune disorders such as SLE

Certain medications can also cause symptoms of Ichthyosis vulgaris to develop: Tagamet (cimetidine), statins (prescribed for high cholesterol), allopurinol (used to treat gout) and certain chemotherapy medications are the most common.

How to Recognise Ichthyosis Vulgaris

Unlike ordinary dry skin or other conditions such as eczema, Ichthyosis vulgaris has several distinctive characteristics:

Body Signs

• Dry scaly skin: Dry scales that resemble fish scales, particularly on the outside of arms and legs. The scales can lift and curl at the edges, making skin feel rough. It also commonly effects the torso (back and tummy) and scalp. 
• Worsening in winter: Dry skin usually dramatically worsens in cold, dry weather
• Persistent dryness: Your skin that remains dry despite religious moisturising and following all the “dry skin rules” such as avoiding long, hot showers etc
• Poor response to conventional treatments: Limited or temporary improvement from regular moisturisers. You’ve probably already tried every moisturiser known to human kind and while some might help, the dryness never goes away.

Face Signs

• Fine, almost invisible scaling that can affect the whole face but is often worse on the cheeks and forehead. The whole scalp can also be affected, covered in dry, flaky skin that resembles dandruff but doesn't respond to dandruff treatments.
• Increased sensitivity to skincare products due to compromised skin barrier

Hand Signs

• Hyperlinear palms (old lady hands): Exaggerated, deeper-than-normal lines on your palms (a key diagnostic feature).
  
  Hands and feet are areas that are usually significantly impacted by Ichthyosis vulgaris.  Many people have what I have termed ‘old lady hands’ since childhood – the skin on the hands is dry, rough and has multiple lines and creases on the palms.  The medical term for this is hyperlinear palms.  The soles of the feet can also suffer from thick, dry skin that can crack into painful fissures. 
• Increased sensitivity to soaps and detergents
• Prone to contact dermatitis.
• Painful cracking, especially in winter
• Persistent dryness despite frequent moisturising

Beyond Dry Skin

People with Ichthyosis vulgaris also have a higher risk of:

• Perioral dermatitis: Inflammatory rash around the mouth
• Acne: Despite having dry skin, the impaired skin shedding can block hair follicles causing acne
• Contact dermatitis: Increased sensitivity and reactions to skincare ingredients, laundry products, dishwashing liquids and other contact and environmental irritants
• Keratosis pilaris: "Chicken skin" bumps, particularly on upper arms and thighs,
• Eczema/dermatitis: Many people with Ichthyosis vulgaris are misdiagnosed with or also have eczema. Ichthyosis vulgaris rarely effects the inside of the elbows and behind the knees which are areas that are usually impacted by eczema – however, skin effected by Ichthyosis vulgaris is more prone to eczema due to the damaged skin barrier. You can read more about the role of filaggrin and eczema here Find out more about filaggrin - National Eczema Society
• Reduced ability to sweat:  Ichthyosis vulgaris can impair your ability to sweat while exercising or in hot weather which can lead to overheating.  While people with Ichthyosis vulgaris still have sweat glands, the build up of dry, dead skin makes it more difficult for perspiration to reach the skins surface where it works to cool the body.
• Increased sun sensitivity: The impaired skin barrier created by Ichthyosis vulgaris can increase the sensitivity of your skin to the sun. 

[Looking for specific product recommendations for Ichthyosis vulgaris and extremely dry or flaky skin? Read my companion article on effective products for dry skin conditions.]

My Personal Journey with Severe Dry Skin and Ichthyosis vulgaris

I’ve had dry skin and old lady hands for as long as I can remember.   As a child, I would slather my skin in sorbolene & glycerin cream twice a day, every day to improve the appearance of the dry, scaly skin on my arms and legs.  Despite this, my skin always felt tight and dry, like it was a few sizes too small for my body.  In winter, the skin on my shins would often become so bad it would crack and bleed despite religiously moisturising. 

Before I learned how to manage Ichthyosis vulgaris, I would NEVER dream of wearing black clothing as it wouldn’t take long before it was covered in a dust of dry, dead skin. Gross!  If you have Ichthyosis vulgaris you’ll know exactly what I’m talking about – when you remove your clothes, dry skin is everywhere!

In my late teens and early 20’s I visited countless dermatologist, beauty therapists and naturopaths trying to find solutions for my very dry and scaly skin. Not a single one of them could give me a reason for my dry skin but everyone would sell me a moisturiser, supplement or diet that they were convinced would fix it.  I did countless food elimination diets and detoxes – gut and liver cleanses with naturopaths. I took endless fish oil and evening primrose oil supplements.  Nothing ever made a difference, and my skin stayed dry and scaly. 

Looking for answers to finally solve my dry skin issue was one of the reasons I decided to leave a career in jewelry to study natural therapies in my early 20’s, but it wasn’t until my 40’s when I discovered Ichthyosis vulgaris by accident while reading an article online.  Further research led me to develop a protocol that allowed me to manage my very dry skin so that it felt and looked normal. Finally, I was able to feel comfortable in my skin (and I was able to buy and wear black and dark coloured clothing!)  

Managing Ichthyosis Vulgaris: What Actually Works

Ichthyosis vulgaris being a genetic condition can’t be cured, but it can be successfully managed with the right approach:

L-Histidine supplementation may help increase Filaggrin

L-histidine is an amino acid that can help increase filaggrin production in some people with Ichthyosis vulgaris.

·        Take 1 teaspoon daily for a full 8 weeks

·        Improvements typically appear between weeks 4-8

·        If effective, maintain with 3 doses weekly

·        Important: The full 8-week trial is essential—many people give up too early, it can take the full 8 weeks to see an improvement and it’s not unusual for the scales to worsen slightly before improvement is seen

·        If L-histidine is taken long-term, you should also take a zinc supplement at the same time

·        While L-histidine can create more normal skin in many people, it’s not a cure, if you stop taking it, your dry skin will return within a few months or sooner.

Chemical exfoliants

Exfoliation is as important to improving the dry skin of Ichthosis vulgaris as moisturising and is often overlooked.

Chemical exfoliants work by dissolving the bonds that keep the dry, scaly and dead skin stuck on the surface - this is one of the underlying issues with Ichthyosis vulgaris, your skin doesn't shed normally and builds up.  Chemical exfoliants are less irritating and more effective than other types of exfoliants, like dry skin brushing or gritty/granular exfoliants which can further damage an already compromised skin barrier. 

Chemical exfoliants such as alpha hydroxy acid and salicylic acid are mostly known and marketed for the treatment of acne and many people with dry skin have been told to avoid them. But chemical exfoliants are game-changers for Ichthyosis vulgaris. 

Exfoliating your skin regularly helps moisturisers work better and removing the build up of dry, dead skin also helps to improve the function of your skin barrier, reducing water-moisture loss.

·        Use on face, scalp, and body

·        High strength urea creams used regularly on feet if prone build up of thick, dry skin that can crack

·        Daily application in winter

·        2-3 times weekly in summer

·        Helps remove dead skin buildup that won't shed naturally

Moisturisers

Managing Ichthyosis vulgaris is a balance of exfoliation and moisturisation.

Impaired skin barrier makes skin affected by Ichthyosis vulgaris more sensitive to irritants found in most moisturisers, especially fragrances and preservatives - so avoid products that contain these. Balms based on beeswax or tallow work best as they’re free from water and water-soluble ingredients, and as a result do not require preservatives.

• Look for products containing olive squalane and organic jojoba oil
• Avoid fragrances, preservatives
• Avoid soaps and harsh cleansers - consider oil cleansing instead of traditional cleansers
• For extremely dry areas, look for products containing beeswax and high-dose tocopherols (natural vitamin E)

Frequently Asked Questions About Ichthyosis Vulgaris

Is Ichthyosis vulgaris curable? No, as a genetic condition, Ichthyosis vulgaris cannot be cured. However, with the right approach, it can be effectively managed to the point where your skin looks and feels normal.

Why do dermatologists often miss diagnosing ichthyosis vulgaris? Many dermatologists focus only on the visible dryness or eczema without checking for specific signs like hyperlinear palms or investigating the genetic component. It's often misdiagnosed as simple dry skin or eczema.

Can children have ichthyosis vulgaris? Yes, it’s present from childhood, though symptoms may become more noticeable during adolescence. The hyperlinear palms are typically present from early childhood.

Is Ichthyosis vulgaris the same as eczema? No, though they can occur together. Eczema is an inflammatory condition while Ichthyosis vulgaris is a genetic disorder affecting skin cell turnover.

Can diet help with ichthyosis vulgaris? While no specific diet cures Ichthyosis vulgaris, some people find that omega-3 supplements and staying well-hydrated can help. Vitamin D and vitamin A supplements can also be helpful. L-histidine supplement can be particularly beneficial for many with. Staying well hydrated is also important as your body loses more water through your skin when you have Ichthyosis vulgaris.  Some people also find that removing gluten from their diet can help to improve their skin.

Learn more about specific products recommendations for Ichthyosis vulgaris.

Disclaimer: This article is for information purposes only and is not intended to replace advice from a qualified health practitioner.