This common condition produces coin-like circular lesions, and in elderly patients may begin initially in an area of asteatosis. Lesions are discrete and much more inflammatory than those of asteatosis. Excoriation of the lesions is prominent, the surface is moist and eczematous, and the surface lacks the canal-like or craquelé pattern. Initially, itching is confined to individual lesions.
This scaling condition in its fully developed form resembles dominantly inherited ichthyosis vulgaris. Thick dirty-brown scales occur over the trunk and extremities and encroach on the skin over the flexural aspects of the large joints. Acquired ichthyosis is usually intensely pruritic and in the early stage may suggest changes of asteatosis. It is a paraneoplastic dermatitis that may precede, follow, or coincide with an underlying malignancy. Hodgkin's disease, mycosis fungoides, other lymphomas, and visceral cancers are most commonly associated. It has also been reported with HIV infection, and does not respond to the simple measures that control asteatosis. Biopsy shows changes of ichthyosis vulgaris and may be helpful in distinguishing difficult cases.
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