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To Exfoliate or Not to Exfoliate?

 

John Browning, MD, FAAD, FAAP

 

Summer is here and, with that, there is commonly much discussion within the ichthyosis community regarding the best practices for exfoliation. Today, we are welcoming back FIRST Medical Guest Blogger, Dr. John Browning, member of FIRST’s MSAB and Chief of Dermatology at Children’s Hospital of San Antonio, as he offers guidance on how, when, or when not, to exfoliate.

I often get lots of questions from my ichthyosis patients about exfoliation. Should I exfoliate?  Is it good for my skin?  How often?   I thought this column might help to shed some light on this very topic.

First of all, what is exfoliation?  Webster’s Online Dictionary defines exfoliate as “to cast off in scales, laminae, or splinters.”  So exfoliation is the act of removing the outer scales from the skin.

For those individuals with hyperkeratotic ichthyosis (i.e. thickened skin) exfoliation may make you more comfortable.  These might be people with CIE, harlequin, or epidermolytic ichthyosis.  Of course exfoliation, while removing the scale, often brings out the underlying erythema or redness.  So you will trade the scale for the redness.  This is not an issue if the scale is more bothersome to you but it is important to keep in mind if you do not want to be red.

In other cases, such as Netherton syndrome, where the skin barrier defect is more severe, the skin should not be further exfoliated.  Exfoliation will only lead to increased sensitivity and irritation.

Some individuals with CIE or epidermolytic ichthyosis prefer to exfoliate by first soaking in a tub for an hour or longer.  They can then use a wash cloth or loofah brush to gently remove the outer layer.  Others might prefer a cream or lotion with ammonium lactate, salicylic acid, or urea to help soften and remove the outer layer.  Those with thick scale under their eyes have found that topical tazarotene can loosen the scales and allow their eyelids to close more fully.  Whatever the method, it is an individual choice and you need to find what works best for you.

Best wishes to all of you for a happy and comfortable summer! – John Browning, MD, FAAD, FAAP

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