At a Glance - Keratoderma vs Haxthausen's disease

Dr Jean Watkins discusses the differences between keratoderma and Haxthausen's disease in terms of aetiology, presentation and management.

Keratoderma can present as thickening of the skin on the soles
Keratoderma can present as thickening of the skin on the soles

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.


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