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LETTER TO EDITOR
Year : 1991  |  Volume : 57  |  Issue : 6  |  Page : 314

Palpable dryness : A useful clinical sign in ichthyosis vulgaris




Correspondence Address:
P Sugathan


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How to cite this article:
Sugathan P, Riyaz N. Palpable dryness : A useful clinical sign in ichthyosis vulgaris. Indian J Dermatol Venereol Leprol 1991;57:314

How to cite this URL:
Sugathan P, Riyaz N. Palpable dryness : A useful clinical sign in ichthyosis vulgaris. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Jun 25];57:314. Available from: http://www.ijdvl.com/text.asp?1991/57/6/314/3722


To the Editor,

Ichthyosiform dermatoses can be differ­entiated from one another by well defined clinical, genetic. and histological criteria. Among these ichthyosis vulgaris is the best investigated and - most common. [1] It is solely cutaneous and a full-blown case offers no di­agnostic difficulty. However, like the skin colour in a pigmented population, the clinical spectrum of ichthyosis vulgaris is wide. Envi­ronmental factors like low ambient humidity and alkaline cleansing materials like soap and detergents used by an ichthyotic patient make the disease more conspicuous. [2] These pa­tients are predisposed to excessive transepidermal water loss [3] and hence more prone to develop irritant contact dermatitis. Detection of even mild forms of ichthyosis vulgaris therefore is essential to advise these patients on the use of soaps and detergents. No clinical, histological or biochemical tests are available at present to detect subclinical forms of ichthyosis vulgaris. Further, it is not often possible to differentiate acquired ichthyosis from the congenital variety on clinical examination.

In our practice in Kerala State, South In­dia, we have evolved a simple clinical test which is consistently positive in detecting even the mildest form of ichthyosis vulgaris. We call it the 'Palpable dryness' and it is elicited as follows

The outstretched palm of the patient is gently palpated from the distal crease of the wrist joint to the tips of the fingers, keeping the examiner's hand at right angle to that of the patient. A peculiar roughness can be felt even in a patient who had hyperhidrosis of the palms. In the mildest form of ichthyosis this dryness is felt only beyond the metacarpo-phalangeal joints. It is not propor­tional to the degree of hyperkeratosis or xerosis but rather to the exaggerated der matoglyphics in these patients. [4] It is so sen­sitive, a clinician can elicit it literally blind­folded without being aware of other clinical features in such patients.

 
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1.Schnyder UW. Inherited Ichthyosis. Arch Dermatol 1970; 102 : 240-252.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Wilkinson JD and Rycroft RJG. Contact Dermatitis. In Text Book of Dermatology 4th Edn. Rook A, Wilkinson DS, Ebling FJG et al (Eds), 1987, Bombay, Oxford University Press, pp 436-437.  Back to cited text no. 2    
3.Frost P, Weinstein GD, Bothwell JW and Wildnauer R. Ichthyosiform dermatoses III. Studies of transepidermal water loss. Arch Dermatol 1968; 98 : 230-233.  Back to cited text no. 3    
4.Esterly NB. Ichthyosiform dermatoses. Paediatrics 1968; 42 : 990-1104.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]




 

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