CYP4F22 is an endoplasmic reticulum-resident cytochrome P450 that catalyzes the ω-hydroxylation of ultra-long-chain fatty acids (preferred substrate ≥C28), a step required for acylceramide production and skin permeability barrier formation (PMID:26056268). It is a type I membrane protein anchored in the ER, positioning ω-hydroxylation of ultra-long-chain fatty acids on the cytoplasmic face of the ER membrane (PMID:26056268). Ichthyosis-associated missense mutations directly reduce ω-hydroxylase activity, correlating enzymatic loss with the drastic depletion of acylceramide observed in patient skin and establishing CYP4F22 deficiency as a cause of autosomal recessive congenital ichthyosis (PMID:26056268). Certain pathogenic mutations (p.R282W, p.R397C) destabilize the protein, and mutant protein levels are partially restored by the HDAC inhibitor trichostatin A, implicating deacetylation-dependent regulation in mutant protein stability (PMID:35014717). Beyond these findings, the structural basis of substrate recognition and the regulatory mechanism linking acetylation to CYP4F22 stability have not been characterized in the available corpus.