S1 guideline for ichthyosis (Germany)
The following bath additives have been shown to have keratolytic effects: sodium hydrogen carbonate (pharmacy‐grade sodium bicarbonate powder or in the form of baking soda [available from wholesale bakery stores]), wheat starch (amylum tritici), rice starch (amylum oryzae) and corn starch (amylum maydis).
The increase in pH associated with the (alkaline) sodium hydrogen carbonate causes a softening and loosening of the hyperkeratosis – presumably through the increased activity of serine proteases. For adults, approximately 6 g of sodium bicarbonate per liter of bathwater – i.e. 3–4 handfuls (around 400 g) of sodium bicarbonate per bathtub – is necessary to adequately promote keratolysis. We generally recommend this treatment only for patients ≥ 1 year of age; for infants/toddlers, the concentration should be halved (approximately 3 g per liter). To simplify matters, commercially available baking soda can be used instead of sodium hydrogen carbonate
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