Description, Causes and Risk Factors:
Palmoplantar keratodermas are a group of disorders characterized by thickening of the skin on the palms of the hands and soles of the feet of affected individuals. The various forms of PPK can be divided into hereditary forms with only skin problems, hereditary syndromes with PPK as an associated feature, and acquired forms. The more commonly seen hereditary PPKs are discussed here.
Hereditary forms may be localized to the hands and feet, or they may be associated with a more generalized skin disorder. Classification of hereditary PPK is frequently confusing. A simple classification incorporates 3 factors: 1) specific form and structure and distribution of the palmoplantar keratosis, 2) presence of associated skin and other tissue (such as nails, hair, mucous membranes) disease in sites other than the palms and the soles, and 3) presence or absence of fragile or blistering skin.
The palmoplantar keratodermas are caused by abnormal proteins in the superficial layer of skin (epidermis). We have several genes responsible for producing these proteins. A mistake (mutation) in any one of these genes causes production of a faulty protein, and this in turn affects the structure of the skin of the palms and soles. Most cases of palmoplantar keratoderma are caused by mutations in the gene that produces an epidermal protein called keratin 9. But there are several other genes and mutations responsible for the rarer types of palmoplantar keratoderma.
Diffuse nonepidermolytic palmoplantar keratoderma is an autosomal dominantly inherited condition traced to KRT1 and KRT16 keratins. Palmoplantar keratodermas are further distinguished by their mode of inheritance and by the presence or absence of associated features. These may include hyperhidrosis, exacerbation of hyperkeratosis by manual labour, nail changes, frequent dermatophyte infections, and severe malodor.
Even, widespread thickened skin (keratosis) over the palms and soles.
Other keratotic lesions may appear on the tops of the hands, feet, knees, and elbows.
Nails may be thickened.
A red band at the edges of the keratosis is frequent.
Palmoplantar keratoderma also causes difficulty with walking, because of pain in the feet. The thick skin and sweating of the feet makes them particularly susceptible to odor, and to fungal infection (athlete's foot). The thick skin on the palms may reduce sensitivity in the finger tips, impairing manual dexterity. All these problems, together with the unusual appearance can be stressful and lead to psychological difficulties.
Diagnosis of palmoplantar keratoderma depends mainly on history,clinical ?ndings, and appropriate histologic or metabolic data. The most common ?ndings on biopsy areimpressive hyperkeratosis, acanthosis, and hypergranulosis.Some forms of palmoplantar keratoderma exhibit prominentepidermolytic hyperkeratosis, characterized by pronounced vacuolization of the keratinocytes of themiddle and upper portions of the epidermis. Thisphenomenon is not speci?c and is also seen in bullous congenital ichthyosiform erythroderma, linearepidermal nevus, and various unrelated conditions.
At present there is no cure for palmoplantar keratoderma. The skin cells are programmed to make a faulty protein and this cannot be corrected. But the symptoms can be improved by the following measures:
The use of simple antiseptics if odor is a problem.
Antifungal cream or tablets if fungal infection is present.
Regular chiropody to pare down the thick skin.
Customized insoles to relieve pressure-points on the feet.
Regular use of moisturizing creams and ointments.
Benzoic acid compounds.
In severe cases a dermatologist may prescribe the drug acitretin. This thins the affected skin. Treatment has to be closely monitored to avoid excessive thinning of the skin and various side-effects of the drug. It is a drug that must never be taken during pregnancy because it can damage the baby.
Topical keratolytics, such as 6% salicylic acid in white soft paraffin, or a gel of 6% salicylic acid in 70% propylene glycol.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
A large-scale scientific review, presented at the European Association for the Study of Diabetes meeting in Berlin, suggests that three to four cups of coffee a day may decrease the risk of developing type 2 diabetes by 25 percent. For the study, the researchers...
A new study, recently published in the European Journal of Preventive Cardiology, suggests that exposure to blue light may help reduce high blood pressure. For the study, a team of researchers assessed whether blue light exposure could produce enough nitric oxide to...
Factors such as age, gender, physical activity, genetics, medical history, body type, and others directly affect not only the desire to lose weight, but also to follow the right diet. Everything is relative, everything is individual. Nevertheless, there are universal...read more
It is very entertaining to be a sport fan. There is a big variety of sport games that are extremely interesting to follow. Moreover, it is always fun to anticipate the score and watch the enthusiasm live. One of the benefits of being sports fan is using different...read more
A new study of nearly 18,000 participants found that those with high fitness at middle age were significantly less likely to die from heart disease in later life, even if they were diagnosed with depression. Doctor's Tips: How to Stay Fit While Treating Depression Dr....read more