A 63-year-old man with a remote history of oropharyngeal cancer presented with a 1-year history of dysphagia, poor oral intake, and a 50-pound weight loss. On exam, he appeared cachectic with diffuse, symmetric scaling, most prominent over his lower extremities (Fig. 1a). He denied associated pain or pruritus. Laboratory testing revealed an undetectable vitamin C level and markedly reduced levels of A, E, B1, and B6. Given his malnourished state, enteral nutrition via a percutaneous gastrostomy tube was initiated. His skin findings were thought to represent a form of acquired ichthyosis (AI) related to nutritional deficiency. Over time, he gained weight and his skin findings progressively improved, with complete resolution by month 6 (Fig. 1b).

Figure 1
figure 1

Skin findings before and after nutritional supplementation.

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Acquired ichthyosis is a non-hereditary cutaneous disorder characterized by rough, dry skin with prominent scaling.1 Skin changes are the result of hyperkeratosis due to disruption of epidermal cornification. The underlying mechanism is debated, though impaired lipogenesis has been proposed.2 AI is often associated with systemic disease,6 including malignancy, autoimmune disease, and nutritional deficiency, in the form of either gross protein–energy malnutrition3 or vitamin deficiency.4 , 5 The diagnosis is generally clinical, and treatment targets the underlying disease state, though lipid-rich lubricants and keratolytic agents can be useful adjuvants.1