This will help hold in moisture. Common causes of acquired ichthyosis include: Ichthyosis vulgaris causes extremely dehydrated skin resulting in thick and scaly skin. They may not be downloaded or re-used for any purpose. Rough bumps on the arms, thighs and buttocks (. Some children with harlequin ichthyosis are already living into their teens and 20s. Currently, there is no known cure for the condition, but the consistent and regular use of moisturizers and exfoliants are often enough to resolve symptoms. For generic types of ichthyosis the symptoms will either appear during childhood or be present at birth. Early diagnosis and treatment can prevent skin cancer, It is quite common for newborns to have dry, flaky, or peeling skin. For those living with Harlequin ichthyosis like little Giovannino in Turin, Anna Riley in New York, and Nelly Shaheen in England, every day is a gift. It is a symptom of dehydration throughout the body. Nonbullous congenital ichthyosiform erythroderma (NCIE): erythroderma and fine white, superficial, semiadherent. Apply the lotion right after you step out of the shower or bath, while your skin is still damp. The scales can affect the way you look. This type of cream can help to slow down the regeneration of your skin. This type accounts for ninety-five percent of the cases of ichthyosis. Ichthyosis is a family of rare skin disorders characterized by thick, scaling patches of skin. White, gray or brown scales on the front of the legs, back of the arms, scalp, back or stomach. It accounts for nearly 95 percent of all ichthyosis cases. Your skin could show different patterns of flaking. It's a type of ichthyosis, which refers to a group of. Cracking of the skin. Results of genetic tests, even when they identify a specific mutation, can rarely tell you how mild or how severe a condition will be in any particular individual. arrow-right-small-blue You can participate in research studies and also receive genetic testing through the National Ichthyosis Registry at Yale University or for more information about genetic tests performed you can visit GeneDx, www.genedx.com. This happens in severe cases and can cause overheating (because perspiration cools down the body). Genes are the codes that tell your body to make proteins, which determine how your body looks and functions. DermNet provides Google Translate, a free machine translation service. Not only does Nelly just enjoy her life, she has found independence and purpose through her job as a sports coach at a local elementary school in Coventry. The main types of keratinopathic ichthyoses are: * Previously called epidermolytic hyperkeratosis or bullous ichthyosiform erythroderma Previously called ichthyosis bullosa Siemens Previously called ichthyosis hystrix. Five-year-old Evan Fascianos mother rubs cream on his neck. Inherited forms of ichthyosis persist lifelong. Decreased maternal serum or urine estriol levels and dehydroepiandrosterone levels can suggest X-linked ichthyosis in the fetus. X-linked ichthyosis is a rare genetic skin disorder in which skin cells don't properly separate or shed. Alpha-hydroxy acids may sting the skin of babies and young children and should be used cautiously or in combination with another mild emollient product. It can be considered a genetic skin condition which means it is inherited or it can occur later in life. For example, no two people with the same disease look quite the same. They also affect how quickly your body sheds or grows new skin cells. All issues pertaining to the care of patients with ichthyosis should be discussed with a dermatologist experienced in the treatment of their skin disorder. Ichthyosis vulgaris is the most common and mildest form of ichthyosis. flaky scalp itchy skin polygon-shaped scales on the skin scales that are brown, gray, or white severely dry skin thickened skin Symptoms of ichthyosis vulgaris are typically worse in winter, when. About 50 percent of those with the condition also have eczema (atopic dermatitis). Harlequin ichthyosis is a rare genetic skin disorder. In 2013, a 20-year-old woman from Arkansas named Stephanie Turner became the first person with Harlequin ichthyosis to give birth to a child. Often helps if you submit the post without the image then edit the post and add the image. The baby is born with a mucus membrane that is over their skin which the entire body sheds. WebMD does not provide medical advice, diagnosis or treatment. DermNet does not provide an online consultation service. arrow-right-small-blue All rights reserved. We have two copies of our genesone from each parent. This type appears on your legs and trunk and usually occurs at puberty. While there is currently no cure for ichthyosis, treatments, such as creams, lotions, and some medications can help manage the symptoms. They also make new skin cells too quickly or shed old cells too slowly. If the cracks are deep enough, an infection may develop. Ichthyosis is a family of genetic skin disorders characterized by dry, thickened, scaly skin. When a person has this skin disorder, the balance of this system is disrupted. This type of ichthyosis appears most often in adulthood and may appear any time before or after the diagnosis of a systemic condition. Inherited types of ichthyosis may be congenital or have delayed onset. The most severe forms of ichthyosis may threaten the life of an affected newborn, but most people with ichthyosis have a normal lifespan. Typically, the face, scalp, palms of the hands, and soles of the feet are free from scales, while the back of the neck is almost always affected. Most forms of the disease are very rare. Topics AZ He is one of only a couple dozen sufferers of Harlequin ichthyosis. This is the mildest form that has mild scaling at birth on into their adulthood. Ichthyosis is characterized by generalised, scaly skin. Resembles ichthyosis vulgaris but develops in adult life. If both of your parents have the gene, youre likely to have a more serious condition than if only one of them has the gene. In rare instances, adults can acquire the condition as a side effect of certain medications or other medical conditions. Impaired hearing or eyesight: skin may build up over the ears or eyes. However, some patients may acquire ichthyosis vulgaris because of a medical illness or in response to a medication. Since the 19th century, its become possible to live with the disease. This is an extremely rare skin disease that is inherited and affects approximately one in six hundred thousand people. It holds moisture inside and keeps out bacteria and other invaders that might make you sick. > Go to the image library. The ichthyosiform dermatoses may be classified according to clinical . If scales appear on the face, its mostly on the forehead and cheeks. People who have very severe ichthyosis may need to spend several hours each day caring for their skin. This type appears on your legs and trunk and usually occurs at puberty. Ichthyosis is a group of skin disorders. Many patients dont realize they have ichthyosis vulgaris because symptoms can be so mild. Their skins thickness also makes it impossible to sweat properly, leading to an uncomfortable rise in body temperature. DermNet provides Google Translate, a free machine translation service. Photo Credit: Science Photo Library/ Science Source, SOURCES: Ichthyosis. Small, raised, red spots -- usually on your shins -- slowly grow into larger, flatter patches. Maximize your donation to FIRST with a company match. We do not endorse non-Cleveland Clinic products or services. In some cases, a skin biopsy is done to help to confirm the diagnosis while in others genetic testing may be helpful in making a diagnosis. Shawky, R. M., Elsayed, S. M., & Amgad, H. (2016). Since the 19th century, its become possible to live with the disease. ", DermNet New Zealand: "Ichthyosis," "Ichthyosis Vulgaris," "Recessive X-linked ichthyosis. Women are unaffected but can carry the disease and pass it on to their sons. X-linked ichthyosis frequently improves in the summer. Those with Harlequin ichthyosis may also have trouble breathing due to the restricted movements of their chest, arms, and legs. Symptoms include dry, itchy skin and scales. This is to make sure that the moisture is left on the surface of your skin. What is the National Ichthyosis Registry? Parents dont have to have the disease to pass the gene onto their children. Ichthyosis vulgaris is the most common type of inherited ichthyosis, affecting 1 in 250 people. Ichthyosis vulgaris. Dry, scaly skin is the main symptom. Ichthyosis is a genetically and phenotypically heterogeneous disease that can be isolated and restricted to the skin manifestations or associated with extracutaneous symptoms. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, http://www.firstskinfoundation.org/types-of-ichthyosis/harlequin-ichthyosis, https://www.aad.org/public/diseases/scaly-skin/ichthyosis-vulgaris, https://rarediseases.org/rare-diseases/ichthyosis-vulgaris/, http://www.firstskinfoundation.org/userAssets/file/IchthyosisVulgaris.pdf, http://www.dermnetnz.org/topics/ichthyosis-vulgaris/, http://www.mayoclinic.org/diseases-conditions/dry-skin/symptoms-causes/dxc-20248892, http://www.mayoclinic.org/diseases-conditions/ichthyosis-vulgaris/basics/lifestyle-home-remedies/con-20024401, http://www.mayoclinic.org/diseases-conditions/ichthyosis-vulgaris/basics/symptoms/con-20024401, http://www.dermnetnz.org/topics/ichthyosis/, A safer blood thinner? Acquired ichthyosis may resolve if the underlying cause can be effectively treated or a causative drug discontinued. Appointments & Access Contact Us Symptoms and Causes Diagnosis and Tests Management and Treatment Outlook / Prognosis Overview Harlequin ichthyosis: A patient's perspective. They might have thick or thin cracks running through them. Living with a rare genetic disease can be difficult, painful, and sometimes even lonely. Your dermatologist can recommend treatments to help your skin look and feel better. Hearing difficulties because of the buildup of way in your ears. Advertising on our site helps support our mission. This is a skin disorder that causes dry scaly skin and is the most common form of ichthyosis. Thickening of the skin on the palms of the hands and soles of the feet. Scales on the skin that are white, gray, or brown. Ichthyosis vulgaris is fairly common, affecting one of every 250-300 people (male and female, and of all races). Ichthyosis vulgaris is also commonly associated with other skin conditions. Moisturizer can lock in moisture from the bath into the skin. One 2011 study that analyzed 45 cases of the disease found only 56 percent of patients survived. They simply believe their skin is dry, so they apply moisturizer, which can reduce scaling. Many types of ichthyoses exist, and an exact diagnosis may be difficult. This type affects around one in two hundred fifty people. The two most common are ichthyosis vulgaris and X-linked ichthyosis. There is one form of this skin disease that does not appear to be genetic, which is referred to as ichthyosis acquista. Creams containing a high percentage of urea or lactic acid have been shown to work exceptionally well in some cases. Products with ceramides or cholesterol also keep skin moist. Certain heavy duty moisturizers that include the chemicals lactic acid, salicylic acid and urea can also help the skin shed properly. Symptoms include dry, itchy skin and scales. Dermatology Made Easybook. Treatment options revolve around lessening symptoms by removing scaling and reducing skin dryness. It had no external nose, but two holes where the nose would have been. As I couldn't add images in here either, I uploaded to a site of mine. Speaking to Good Housekeeping about her experiences with the disease and motherhood, Turner said: Since becoming a mom, my skincare regimen has evolved. The problems they encounter may include: There is no cure for the inherited forms of ichthyosis. Ichthyosis is a skin disease with more than 20 varieties. X-linked recessive ichthyosis. Otherwise, the disease can be evident from birth based on appearance alone. There may be a general presentation in a family or consistent findings for a particular diagnosis, but it's important to know that every individual is different. Doctors may determine the type of ichthyosis you have by identifying the: The symptoms of ichthyosis can range from mild to severe. Kava ichthyosis Ichthyosis refers to a relatively uncommon group of skin disorders characterized by the presence of excessive amounts of dry surface scales. And while a diagnosis of Harlequin ichthyosis once meant a certain death sentence, early intervention and neonatal care have been shown to prolong life. [9] Ichthyosis of varying severity is well documented in some popular breeds of domestic dogs. Rub cream, lotion, or ointment onto your skin every day to add moisture. ichthyosis vulgaris This is a protein that helps create the skins natural barrier. When a newborn baby in Turin, Italy was abandoned by his parents after they discovered he had Harlequin ichthyosis, nurses at the local hospital stepped in to help care for him. J Am Acad Dermatol 2010; 63: 60741. If you have any concerns with your skin or its treatment, see a dermatologist for advice. The main feature of ichthyosis vulgaris is dry, thick and scaly skin. X-Linked Ichthyosis: A Patient's Perspective: A Clinical Perspective. Female carriers of X-linked ichthyosis occasionally report dry skin problems and, rarely, shadows of scales on the skin. Note that this may not provide an exact translation in all languages, Home What symptoms a person will have depends on what is causing ichthyosis and they type that you have. I like to do things, go out and enjoy my life.. 2023 Healthline Media UK Ltd, Brighton, UK. Foundation for Ichthyosis & Related Skin Types, Inc. - PO Box 1067, Lansdale, PA 19446 - info@firstskinfoundation.org, Copyright 2010-2023 Foundation for Ichthyosis & Related Skin Types, Inc. - Site Map - Privacy/Permissions Policy Ichthyosis vulgaris is also commonly associated with keratosis pilaris, a condition where hair follicles become clogged with skin scales. Common and Distinctive Types of Ichthyosis. Find out if any of your blood relatives have similar skin conditions. Turner was survived by her loving husband and two children. Nearly everyone > 60 years has dry skin. Created 2013. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Related information. Individuals with both conditions have an increased risk of: Most people with both ichthyosis vulgaris and eczema tend to present with severe symptoms at a young age that persist into adulthood. In November of 2019, a woman was arrested after making numerous threats via Instagram, Facebook, and even the GoFundMe page of a New York mother whose toddler, Anna Riley, suffers from Harlequin ichthyosis. (For more information on which products contain these ingredients, request the Foundations Skin Care Products List.) This system, which is used on the following pages and relies on few sophisticated tools and tests, has worked remarkably well for diagnosing and classifying most patients with ichthyosis. The symptoms of ichthyosis vulgaris are the same whether it is inherited or acquired. Babies with X-linked ichthyosis often appear normal when they are born, but the skin abnormalities will almost always show up by their first birthday. Body odor because the spaces between and under your skin flakes can harbor a collection of fungus or bacteria. Our expert physicians and surgeons provide a full range of dermatologic, reconstructive and aesthetic treatments options at Cleveland Clinic. There are more than 20 different types of ichthyosis, but ichthyosis vulgaris is considered the most common form. What can you put on a newborn's dry skin? The most common symptoms include: Depending on the type of ichthyosis, other symptoms may include: Changes to one or more genes cause all of the inherited types of ichthyosis. Approximately 50% of adult males and some female carriers will have asymptomatic comma-shaped corneal opacities (cloudy spots), which do not affect sight. Individuals with one copy of the abnormal gene tend to have milder cases than those with two copies. Key findings are the most characteristic and constant changes found in the skin. X-linked ichthyosis is carried on the X sex chromosome. Ichthyosis is a group of about 20 skin conditions that cause skin dryness and scaling. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. The two most common types are: Ichthyosis vulgaris. Vascularizing keratitis, which is more commonly found in congenital keratitis-ichythosis-deafness (KID), may worsen with isotretinoin therapy. These include: Ichthyosis is usually a clinical diagnosis. You may get this changed gene from one or both parents, or the gene might stop working properly on its own. Men who have X-linked ichthyosis will have unaffected sons (they get their X chromosome from their mother), but their daughters will all be carriers. Ichthyosis vulgaris may present as skin dryness with accompanying fine, white, or skin-colored scales. There are at least 20 varieties of ichthyosis, including inherited and acquired forms. Ichthyosis is a disorder of cornification, characterised by persistently dry, thickened, 'fish scale' skin. This will remove dead skin. Some easy ways to reduce the likelihood of worsening symptoms include: Actinic keratosis is a precancerous skin condition that causes patches of rough, patchy lesions. And she has not only survived, but thrived. X-linked ichthyosis responds relatively well to topical treatment with alpha-hydroxy acids, which accelerate the shedding of the stratum corneum. Ichthyosis is a relatively common condition, impacting approximately 1 in every 250 people. Ichthyosis has been found to be more common in Native American, Asian, Mongolian groups. The doctor might perform a biopsy (removing a small portion of the skin for examination under a microscope). In 2013, Stephanie Turner became the first person with Harlequin ichthyosis to have children. The cause of acquired ichthyosis is unknown. (Take this step only if directed by a doctor.). with symptoms that include dry skin, itching, and redness, cracking, and scales on the skin. Rub scales gently with an abrasive sponge while bathing, after the bathwater has softened the scales. Who gets ichthyosis? Then, see how one woman sweat blood for three years before finally seeking medical help. This is called inherited ichthyosis vulgaris. tree man syndrome, the extremely rare condition that turns people into living, breathing pieces of bark, one woman sweat blood for three years before finally seeking medical help. arrow-right-small-blue [1] The more than 20 types of ichthyosis range in severity of symptoms, outward appearance, underlying genetic cause and mode of inheritance (e.g., dominant, recessive, autosomal or X-linked ). Ichthyosis is a family of genetic skin disorders characterized by dry, thickened, scaly skin. Most cases of ichthyosis are mild. The condition can begin in childhood, often in the first year of life. 2005 - 2023 WebMD LLC, an Internet Brands company. Harlequin ichthyosis, sometimes called Harlequin baby syndrome or congenital ichthyosis, is a rare condition affecting the skin. While rare, in some people with ichthyosis vulgaris, scaling interferes with the sweat glands causing either excessive sweating (hyperhidrosis) or an inability to sweat. Adults can also develop the disease. There are at least 20 varieties of ichthyosis, including inherited and acquired forms. . Read It And Weep: 2019's Funniest News Stories That Put Us In Tears, What Stephen Hawking Thinks Threatens Humankind The Most, 27 Raw Images Of When Punk Ruled New York, Join The All That's Interesting Weekly Dispatch, Steven Schloss/Barcroft Media/Getty Images. Your dermatologist may suggest that you use retinoid cream which is derived from vitamin A for some of the types. Different names have been used over the years to describe individuals who we now believe had the same disease. Acquired ichthyosis shows up in adulthood. But my two-year-old daughter is playing with my toothbrush in the bathwater and my three-year-old son is throwing towels. People with ichthyosis may have a systemic disease, such as: Ichthyosis may be provoked by certain medications: The inherited forms of ichthyosis occur as a result of genetic mutations that alter the appearance and behaviour of keratinocytes (skin cells) in the stratum corneum (the outer skin barrier layer). Department of Health and Human Services. Scaling can lead to complications such as: Ichthyosis can cause emotional issues, too. All forms of ichthyosis include dry, rough, scaly skin. And while there is currently no cure, modern medical advancements have greatly improved the life expectancy and quality of life of those who are diagnosed with the illness. Another potential cause of ichthyosis vulgaris is a gene mutation (change) that can occur during fetal development. American Academy of Dermatology: "Dry Skin: Who Gets and Causes. The presence and frequency of findings in other parts of the integument, such as hair or nails, are mentioned only when they are thought to have the same cause as the ichthyosis. The eyes appeared to be lumps of coagulated blood, turned out, about the bigness of a plum, ghastly to behold It lived about 48 hours.. Symptoms, including how bad they and which organs they affect. It is present at birth throughout your life. A vast majority of ichthyosis cases are inherited. He is one of only a couple dozen sufferers of Harlequin ichthyosis. Figure 1 illustrates a patient with Harlequin ichthyosis. Both types of ichthyosis are considered . Trying to insert an image. These symptoms can include: In the winter time and dry climates the symptoms will usually be worse. Diabetes has not been definitively linked to acquired ichthyosis or ichthyosis vulgaris; however, there are case reports associating new onset ichthyosis with diabetes.[6]. Sometimes patients notice ichthyosis vulgaris symptoms before they are diagnosed with more serious diseases. Most cases of ichthyosis vulgaris are caused by a mutation in the gene responsible for encoding filaggrin. Often, the skin will also flake. Treating ichthyosis dermatologists prefer to use a non-invasive form of treatment. Website Design and Development by AIMG, Clinical Trials & Patient Recruitment Opportunities, FIRST Awareness Spirit Items & Publications, Autosomal Recessive Congenital Ichthyosis (ARCI) - Congenital Ichthyosiform Erythroderma (CIE) type, Autosomal Recessive Congenital Ichthyosis (ARCI) - Lamellar Ichthyosis Type, Ichthyosis Hystrix with Deafness (HID) Syndrome, FIRST Medical & Scientific Advisory Board. The skin was dry and hard and seemed to be cracked in many places, somewhat resembling the scales of a fish. This is because the humidity and warmth will help to improve the symptoms. Exposure to sunlight may improve[citation needed] or worsen the condition. Harlequin ichthyosis is the result of either a lack of this protein or a severely lowered amount of it. ", National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Ichthyosis. Take baths more than once a day. Ichthyosis vulgaris: Symptoms. Why are the images hidden by default? Author: Vanessa Ngan, Staff Writer, 2003. Acquired ichthyosis appears in adult life. In the future, an individual's personal genetic makeup (their genetic diagnosis) will become increasingly important in the diagnosis, classification and prognostication for that individual. Acquired ichthyosis SPAM PROTECTION - DO NOT FILL THIS FIELD IN. Policy. Names and classification of ichthyoses are evolving with a greater understanding of the molecular causes of the diseases [1]. We avoid using tertiary references. The patient may be taking a drug known to cause dry skin. Inability to perspire (sweat) adequately. There can be ocular manifestations of ichthyosis, such as corneal and ocular surface diseases. Steven Schloss/Barcroft Media/Getty ImagesFive-year-old Evan Fascianos mother rubs cream on his neck. Also, dead skin cells dont shed quickly enough, causing a buildup of scales. This type accounts for ninety-five percent of the cases of ichthyosis. There are many other rare types of ichthyosis with defined gene abnormalities and clinical features. The newborn infant is covered with plates of thick skin that crack and split apart. [2] Ichthyosis comes from the Greek ichthys, literally "fish", since dry, scaly skin is the defining feature of all forms of ichthyosis. skin: small, dark, firmly adherent scales; accentuated on sides of neck and trunk; generally spares face, palms, soles, antecubital and popliteal flexures, eyes: asymptomatic, white spots in cornea (50%), nervous system: mental retardation or other neurologic abnormalities (rare), obstetric: prolonged labor in mothers of affected sons (usual). Ichthyosis gene mutations affect the proteins that protect your skin and keep it moist. When I wake up, my skin is super dry and tight, so I have to take a bath every morning. NIHTurning Discovery Into Health In the summer, the disease can virtually disappear because of the warm, moist air. Lastly, some individuals have clinical features that do not permit easy assignment to existing categories or diagnoses. It leads to dry, itchy skin that appears scaly, rough, and red. [5] For example, non-syndromic ichthyoses that are inherited recessively come under the umbrella term autosomal recessive congenital ichthyosis (ARCI). One case with symptoms matching CHILD syndrome has been described as having a likely-different cause.[7]. National Organization for Rare Disorders. Inability to sweat because skin scales clog the sweat glands. Inherited forms of ichthyosis Inherited types of ichthyosis may be congenital or have delayed onset. Still, even close medical attention cant ensure survival. As shocking as this whole thing has been, I pray that instead of getting angry you would choose to make a positive out of this and donate to the foundation for ichthyosis.. Fluid-filled blisters may occur which may become infected and give rise to a foul skin odour. It is found on the extremities and trunk. Before bathing, apply petroleum jelly or other thick, bland emollients to open sores or deep cracks. Ichthyosis vulgaris is most often caused by ones genes (inherited). Extremely dry, scaly skin is known as xerosis. Ichthyosis can also be due to a new spontaneous mutation. There are several types of ichthyosis. (http://www.firstskinfoundation.org/types-of-ichthyosis/ichthyosis-vulgaris), (https://rarediseases.info.nih.gov/diseases/6752/ichthyosis-vulgaris), (https://rarediseases.org/rare-diseases/ichthyosis-vulgaris/), Thick, rough skin that looks dirty, most noticeably on the palms and soles of the feet. Get useful, helpful and relevant health + wellness information. Once scaling subsides, the skin is better able to take in and retain moisture. The two most common types are: Inherited ichthyosis is a genetic condition. Is the ketogenic diet right for autoimmune conditions? Extra lines on the palms of the hands and the soles of the feet. Scaling can also lead to general discomfort and pain and make the skin more vulnerable to irritation and further drying. Dry skin that starts in early childhood may be one of about 20 types of ichthyosis (fish-scale skin). "Inconclusive" results occur occasionally, and this reflects the limitation in our knowledge and techniques for doing the test. Epidermolytic ichthyosis Wikimedia CommonsAn 1886 illustration of a newborn with Harlequin ichthyosis. Like Shaheen, Mui Thomas has pursued her love of sports despite her condition. For some children with ichthyosis vulgaris, the scales become less noticeable during puberty. IMPORTANT NOTE: DermNet does not provide an online consultation service. Get the latest scientific news and resources on diseases of the bones, joints, muscles, and skin from the NIAMS. When this happens your skin cells will accumulate into thick flacks that stick to the body. Oji V, Tadini G, Akiyama M et al. When there are changes or mutations to a gene, it can cause disease. In ancient Greek ichthys means fish. There are several different forms of ichthyosis with each one presenting itself in a different fashion. To help keep your skin moisturized you need to use moisture-retaining ointments or creams after bathing. By contrast, some people whose ichthyosis looks very similar actually have mutations in different genes and, thus, the cause of their ichthyosis is different. Pictures and symptoms of the red, scaly rash. The genetic defect in X-linked results in a deficiency of the enzyme, steroid sulfatase. Sometimes the edges of the scales curl, making the skin feel rough. It is hard to be different in this day and time, she said.
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