Keratoderma is a disorder of the skin that leads to increased keratinization fϋ. This condition is also known as hyperkeratosis, in which the top layer of the skin thickens.
What is keratoderma?
Human skin is composed of different layers. The epidermis, which is also called the cuticle, is the top layer of the skin. This layer serves to protect the skin from environmental inflϋuences. The epidermis also consists of different layers. These include the inner basal layer, stratum balase, the spiny layer, stratum spinosum, the granular layer, stratum granulosum, the lucent layer, stratum lucidum and the outer horny layer, stratum corneum. The epidermis consists mainly of keratinocytes. These are cells that produce keratin. These cells become horny when they pass from the lower layers to the uppermost layer of the epidermis. In this case they are called horny cells or corneocytes. The horny layer consists exclusively of corneocytes. The cells are dead and form the horny layer. If there is a disturbance in the formation of this horny layer, this disease is called keratoderma. Thickening of this horny layer occurs in different parts of the body. These thickenings can occur in large areas or only in specific areas.
Causes
Keratoderma refers to a group of diseases with the same symptoms. However, they are caused by different etiologies. Hereditary palmoplantar keratoses are hereditary disorders. This group includes diseases such as diffuse or focal palmoplantar hyperkeratosis. These two groups are again subdivided. Diffuse palmoplantar hyperkeratosis includes conditions such as Greither syndrome or click syndrome. Focal palmoplantar hyperkeratosis includes acrokeratoelastoidosis Costa as well as keratosis palmoplantaris striata. Follicular hyperkeratosis also belongs to the keratoderma group. Erythrokeratoderma is also a hereditary disease. In addition, porokeratosis is an autosomal dominant hereditary disease. Dyskeratotic-acantholytic keratoses such as Darier’s disease are also autosomal-dominant inherited diseases. In addition to mutations, which are inherited, there may be other causes fϋr kerotoderma. These include certain infections and increased UV radiation. Mild forms of keratoderma may also occur. These are manifested by calluses, especially on the hands and wrists, when the skin is subjected to heavy wear and tear. This is usually referred to as hyperkeratosis. The keratinization of the skin can also be caused by other diseases such as psoriasis, ichthyosis or acne. Keratoderma occurs due to increased cell proliferation in the epidermis or decreased natϋrial detachment of the stratum corneum.
Symptoms, complaints, and signs
In keratoderma, cornification of the outermost layer of the epidermis occurs. Depending on the disease, different areas of the body are affected by this keratinization. In hereditary palmoplantar keratoses, keratinization mostly occurs on the hands and Fϋβen. Follicular hyperkeratosis is a mild condition that only leads to minor cornification of the skin fϋ. The affected person is only slightly affected, as there is no disturbance of movement, which can occur with severe cornification. In eryhrokeratoderma, cornification and skin redness occur. These skin rednesses are also called erythema and occur due to a local circulatory disorder. Prokeratosis is manifested by the appearance of lesions and scales on the skin. These occur mostly on the extremities, as well as on the trunk and mucous membranes. Dyskeratotic-acantholytic keratoses are manifested by the appearance of keratinization on the body already in adolescence.
Diagnosis and course of the disease
Diagnosis in keratoderma is made by examination of the skin. The noticeable changes in the skin in the form of cornification, the increased formation of scales and redness could be detected by a specialist. If the keratoderma is not treated, depending on the type of keratoderma, the affected areas may spread. In addition, keratinization of the skin may progress until the patient is unable to move in the affected areas.
Complications
Keratoderma primarily causes severe discomfort, mainly on the patient’s skin.In many cases, this also results in reduced self-esteem or inferiority complexes, as those affected no longer conduct themselves beautifully. Depression can also develop as a result of this disease. The cornification occurs mainly on the feet and hands. As a rule, this does not lead to any particular restrictions in movement or in everyday life. However, scales can also form on the skin, which affect the appearance of the affected person. Furthermore, it is not uncommon for blood circulation to be disturbed, so that extremities may appear cold. Keratoderma is usually treated with the help of medication and cosmetic surgery. The symptoms can be relatively well limited, although the cosmetic procedures usually have to be repeated several times. Life expectancy is not altered or limited by keratoderma. It is not uncommon for this condition to occur in addition to other skin conditions, so complications or discomfort may result from the other conditions as well.
When should you go to the doctor?
Changes and abnormalities of the usual skin appearance should be examined and treated by a doctor. If keratinization of the upper skin layer on the feet occurs without an apparent reason, a doctor should be consulted if the affected person does not achieve any improvements in self-help. In many cases, sufficient foot care and the wearing of healthy footwear is sufficient to achieve relief from the existing symptoms. If, on the other hand, the symptoms continue to spread or if pain and malpositioning of the feet occur, a doctor should be consulted. A visit to the doctor is advisable in the event of restricted mobility, incorrect posture of the hips or pelvis, or impairment of the usual physical performance. If there are circulatory problems, cold limbs, a general feeling of malaise or a continuous decrease in the usual muscle strength in the legs, a visit to the doctor is required. Lesions, scaling of the upper layers of the skin or redness of the skin, should be examined and treated. If mental and emotional irregularities develop in addition to the physical problems, a visit to the doctor is recommended. In the case of depressed mood, withdrawal behavior, intense feelings of shame or behavioral abnormalities, the risk of mental illness increases without adequate support. Preventive care is necessary to avoid further diminution of well-being.
Treatment and therapy
Depending on the severity, keratoderma can be treated cosmetically using keratolytics. These are substances that soften and dissolve the keratinization. They induce keratolysis, a process in which the horny cells are detached from the epidermis. Retinoids such as isotretinoin or acitretin are effective keratolytics. They also include urea, salicylic acid, alpha-hydroxy acids, azelaic acid, and benzoyl peroxide. This leads to softening of the hyperkeratosis, which then has to be removed. This is done with the help of peelings, pumice stone or callus shavings. Keratoderma can also be treated hormonally, depending on the case. Keratoderma can also occur as a concomitant of other diseases. These are diseases such as dermatitis, scabies, Sézary syndrome, Reiter’s syndrome or reactive arthritis and human papillomavirus. In such cases, the underlying disease must be treated to address the cause of keratoderma.
Outlook and prognosis
In a milder form of keratoderma, medical treatment is not always required. The cornifications that occur can usually be treated with keratolytics such as salicylic acid or uric acid, which show a horn-dissolving effect and reduce the horny layer. As a further possibility baths offer themselves, in whose consequence the Verhornung is removed by means of Hornhautraspel or pumice stone. Also special Peelings or Hornhautmasken for the feet can provide for relief. In everyday life, care should be taken not to irritate the skin unnecessarily and to prevent injuries. Loose clothing made of linen and cotton, in contrast to silk fabrics, does not stick to the cornification and does not irritate the skin. If weather conditions permit, open-toed shoes are advisable so that the skin can breathe and not too much pressure is exerted on it. This also avoids sweating, which in turn could lead to possible skin irritation.If injuries, redness or other symptoms occur or if there is no relief despite the measures applied, a doctor must be contacted without fail. He will check whether keratoderma is actually present or whether the symptoms are based on another disease and will initiate an appropriate therapy. As a rule, this is hormone therapy with thyroxine, supplemented with sufficient vitamin A.
Prevention
Depending on the type of keratoderma disease, preventive measures can be taken. In the case of mild keratoderma, which arises due to severe stress on the skin, the cause fϋr this stress can be avoided. An example of this is the wearing of unflattering shoes, which can lead to hyperkeratosis on the feet. There are no preventive measures for inherited forms of keratoderma. These forms must be treated, but they always recur. In diseases associated with keratoderma, such as human papillomavirus infection, early treatment can prevent the development of keratoderma.
Follow-up
Aftercare for keratoderma depends on the nature of this disease. If the condition is only mild, it is possible to alleviate skin problems by reducing exposure. For example, cornification on the soles of the feet can be avoided by having patients wear more comfortable footwear. If it is an inherited form of the disease, direct prevention is not possible. Follow-up treatment is intended to reduce cornification in the long term. With the help of keratolytics, patients can remove the affected skin areas themselves. This can be done, for example, with salicylic acid in which the feet are soaked. This is followed by targeted treatment with pumice stone or a callus rasp. Peeling products, if necessary together with soothing agents, can also be used for successful aftercare. In a difficult case, the doctor recommends hormone treatment. Patients should then take the prescribed hormones as directed by the doctor. Regardless of the treatment measure, it is important to take care of the skin sites. Otherwise, there is a risk of complications or injury. If parts of the body other than the feet are affected, doctors advise wearing loose clothing. This does not irritate the sensitive skin and allows good air circulation. To rule out infection, patients should not rely solely on self-help measures, but should seek medical attention.
What you can do yourself
Keratoderma does not always require medical treatment. In mild cases, keratolytic agents such as salicylic acid, azelaic acid or benzoyl peroxide can be used to treat the cornifications yourself. The softened skin can then be removed with a callus rasp or pumice stone. Peels also exfoliate the skin and can be used in conjunction with a mild sedative. In severe cases, keratoderma requires hormonal treatment. If the keratoderma cannot be treated by the above measures, a doctor must be consulted in any case. If the complaints occur as a concomitant of another disease, medical advice is also indicated. Concomitantly, the skin must be spared in order to avoid injuries and further complications. If keratoderma is present on the foot, it is best to wear open-toed shoes. If other parts of the body are affected, loose clothing that does not irritate the skin is recommended. Cotton and linen are ideal. When doing sports, clothing made of polyester should be worn. If the cornification does not recede despite all measures, medical advice must be sought. In case of injuries, redness and other discomfort, refrain from further self-help measures.
