Keratoderma
Aetiology
- May be hereditary, with symptoms presenting in early childhood.
- May also develop later in life.
- May be associated with internal malignancy, eczema, psoriasis or lichen planus.
- Caused by: immersion in water; infections such as HPV, crusted scabies or syphilis; drugs including arsenic, verapamil, lithium and fluorouracil; systemic disease including myxoedema, diabetes mellitus, cutaneous T-cell lymphoma and chronic lymphoedema.
- May also be caused by low protein diets or vitamin deficiency.
Presentation
- Keratoderma presents with diffuse, linear or hyperkeratotic thickening of the skin on the soles of the feet or palms.
- Discomfort or pain on walking.
Management
- Skin scraping to check for fungal infection.
- Salt water soaks.
- Topical keratolytics, such as salicylic acid 5%, lactic acid 10% and urea 10-40%.
- Topical retinoids, such as tretinoin. Potent topical steroids.
- Intermittent acitretin (avoiding during pregnancy).
- Dermabrasion.
Keratoderma climactericum is associated with obesity and hypertension
Keratoderma climactericum (Haxthausen's disease)
Aetiology
- Occurs in women at time of menopause.
- Associated with obesity and hypertension.
- Hormone profiles are usually normal.
- Sometimes seen as a form of eczema or psoriasis.
Presentation
- Usually affects the sole of the feet around the margins of the heel and under the metatarsal heads.
- Palms of the hands may be affected with discrete, centrally placed lesions.
- Presents with erythema, hyperkeratosis and painful fissures.
Management
- Advise weight reduction and BP control.
- May be helped by emollients: topical triamcinolone 0.1%, estradiol 0.05% or urea 25-40%.
- Some patients may respond well to acitretin.
