Brief overview
- What is pachyderma? Thickened, hardened skin or mucous membrane.
- Treatment: Treatment depends on the trigger of the skin thickening. Applied treatments include creams, tinctures, ointments and medications.
- Causes: Enlarged skin cells caused by skin irritation (e.g., friction or pressure) and/or disease (e.g., atopic dermatitis).
- Diagnosis: Discussion with the doctor, physical examination (measurement of skin density if necessary).
- Prevention: skin care with special creams and ointments (water-oil emulsions), balanced diet
What is pachyderma?
Pachyderma is the technical term for excessively thickened and/or hardened skin or mucous membrane. It is also colloquially called elephant skin. Skin thickening usually develops as a result of recurrent inflammation of the skin. These occur, for example, in certain diseases such as psoriasis or neurodermatitis.
Skin thickening or hardening can also occur when those affected place excessive stress on the skin in a particular area. In this case, the skin thickens to protect the underlying tissue (so-called callus).
What helps against elephant skin?
After the doctor has found the cause of the skin thickening, he decides together with the affected person on the further treatment steps. These depend on the trigger of the skin thickening.
Treat the underlying disease
If the patient suffers from neurodermatitis, for example, and this is responsible for the thickening of the skin, the doctor treats the underlying disease. For example, he prescribes moisturizing skin creams that relieve itching.
However, medications such as cortisone are also used specifically for neurodermatitis and other inflammatory diseases. These inhibit pro-inflammatory messenger substances in the body and thus alleviate the symptoms that occur.
Avoid skin irritation
If the thickening of the skin is caused by external skin irritation (e.g. by pressure or friction), dermatologists recommend avoiding the triggering irritant. For example, if you have calluses on your feet, make sure you do not wear shoes that are too tight.
Skin care
In the case of skin thickening, proper skin care is also important. The main thing is to provide the skin with sufficient moisture.
Creams and ointments
Care creams with urea (Urea) are also suitable. The urea contained binds moisture in the upper layers of the skin and protects the skin from drying out.
Remove calluses
The skin forms calluses as a natural protective reaction against friction or pressure (e.g. from shoes that are too tight). In principle, calluses do not need to be removed. However, if you find the excessive callus, for example on your feet, annoying, it is possible to remove it.
With appropriate tools such as pumice stones, callus files and callus rasps, the callus can be carefully removed. Before treatment with files and planes, doctors recommend a foot bath to soften the callus. This makes it easier to remove. A nourishing peeling helps to remove excess skin flakes and to smooth the skin surface.
To avoid possible injuries when removing stubborn calluses, doctors advise professional (medical) foot care (e.g. by a podiatrist).
Salicylic acid also has an antibacterial and anti-inflammatory effect. Skin irritations can heal more quickly. The products containing salicylic acid and urea are available in pharmacies in both liquid (e.g. solution, tincture) and semisolid (e.g. cream, gel, ointment) dosage forms.
Ask your doctor or pharmacist which agents and care products are best suited for your skin and how to dose them.
Operation
In some cases, thickened callus is a sign of chronic inflammation of the skin (dermatitis). It is scarred, and calluses (tyloma) form. If affected persons have pain as a result (e.g. in the case of a corn) or if they find the skin change visually extremely disturbing, the doctor also removes the thickened skin surgically. To do this, the patient first takes a foot bath with warm water to soften the callus. The doctor then carefully removes the superfluous horny skin layers with the help of a suitable instrument (e.g. a cutter or scalpel).
Correcting foot malpositions
If the callus forms as a result of pressure points caused by a foot malposition (e.g. in the case of a flat or splay foot), those affected can relieve this by wearing wide-cut and comfortable shoes. In addition, insoles and special training of the foot muscles can help to correct the malposition and thus relieve the pressure from the stressed skin.
Is pachyderma curable?
Skin thickening is basically curable. If those affected avoid the underlying trigger and the doctor treats the affected skin area correctly, the thickened skin can also be eliminated. In many cases, it is possible for those affected to successfully treat the skin thickening themselves at home.
How does elephant skin develop?
In pachyderma, the outer cell layer of the skin (epidermis or cuticle) is stimulated to enlarge (called hypertrophy). The most common causes are certain diseases and prolonged irritation of the skin.
Decreased sebum production (sebostasis).
If the sebaceous glands secrete too little sebum, the skin loses water and thickens. In more than 80 percent of cases, sebostasis is age-related, as sebum production naturally decreases with age. In women, for example, changes in hormone balance during menopause are sometimes responsible for the skin producing less sebum and thus becoming dry.
Other causes of sebostasis are: Vitamin deficiency (e.g. vitamins C, E and A), lack of fluids, external influences such as excessive UV radiation due to too long sunbathing, air polluted with dust and exhaust gases, synthetic cosmetic products (e.g. containing substances such as polyethylene glycol, parabens, kerosenes, silicones, artificial fragrances, emulsifiers).
As a symptom of chronic skin diseases such as neurodermatitis (atopic eczema) or psoriasis, skin thickening (so-called lichenification) also occurs. As a result of the disease, the skin becomes horny and thickens. As a result, it often looks leathery.
Especially in the area of the wrists, elbows and back of the knees, the skin is often thickened and less elastic. The skin also sometimes thickens in cases of contact allergy, in which eczema forms due to contact with certain substances (e.g. metals, cleaning agents, latex).
Prolonged stress of the skin
If the skin is permanently stressed in a certain place, it reacts with a so-called hyperkeratosis. In this process, healthy skin cells die and turn into dead horny cells. The skin thickens, and callus (also called tyloma, horny callus or skin callus) develops. It protects the skin from external influences such as friction or pressure and often appears on the foot (on balls and heels).
Calluses can also develop on the hands and (with appropriate stress) in other areas of the body. It usually forms where the skin is exposed to friction and pressure over a long period of time. The best known form of tyloma is the so-called corn on the foot. It develops, for example, when shoes that are too tight place a permanent strain on the skin.
Symptom in other diseases
Areal skin thickening or swelling also occurs as a symptom of other conditions. These include, for example:
- Cutis verticis gyrata: rare congenital disorder in which the scalp is malformed and wrinkles develop
- Pachydermoperiostosis: rare, inherited disorder in which the skin thickens and wrinkles develop, among other symptoms
- Lichen myxoedematosus and scleromyxedema: rare skin disease in which lichen-like nodules (poplars) develop on the skin and the skin thickens and hardens over a wide area
- Erythropoietic protoporphyria: rare metabolic disorder; the skin itches, burns and reddens when exposed to sunlight; the skin thickens
- Interaryt(a)enoid pachyderma: a form of pachyderma in which the tissue of the mucous membrane of the larynx is severely thickened, whitish and distinctly puckered and covered with small warts
- chronic edema (water retention): Swelling due to accumulation of fluid in the tissue (usually on legs or ankles), e.g., in liver cirrhosis and chronic venous insufficiency
- Elephantiasis: enlargement or swelling of a part of the body (e.g. legs or external genitalia) due to accumulated lymph fluid (lymphedema) that is no longer sufficiently removed by the lymphatic channels.
- Cancers of the lymphatic and/or blood system (e.g., non-Hodgkin’s lymphoma or leukemia).
The skin appears – similar to elephants – horny, wrinkled, swollen and dry. Those affected often report itchy and painful skin areas. Spots on the skin are also visible in some cases. Skin thickening such as calluses occur particularly on the soles of the feet and palms of the hands.
How do you recognize pachyderma?
If the affected person notices skin thickenings that are painful or appear unusual, the general practitioner is the first point of contact. If necessary and for further examinations, he or she will refer the patient to a dermatologist.
Discussion with the doctor
Before the actual examination of the skin, the physician conducts a detailed discussion with the affected person (anamnesis). Among other things, he asks questions about existing skin problems and changes, for example, where they first appeared, whether they arose suddenly or developed over a longer period of time, whether there are possible triggers for the skin thickening (e.g., shoes that are too tight), whether the affected person has other diseases (e.g., neurodermatitis).
Physical examination
What skin changes are looked for?
In order to describe the skin thickening as accurately as possible and find clues to the triggering cause, the doctor pays attention to the following:
- Type of skin change: Is it a skin thickening, nodules (e.g. also in skin cancer or warts), blisters (e.g. in neurodermatitis or shingles), scales (e.g. in psoriasis) or spots (e.g. in hives)?
- Skin color: Is the skin reddened or yellowish or bluish in color?
- Skin texture: Is the skin thickened? Are nodules palpable? Is the skin rough and dry?
- Demarcation from healthy skin: Are the edges of the thickened skin clearly demarcated from the healthy skin? Do they look even or irregular?
- Size and spread of the skin changes: Are the skin changes distributed over a large area, in the form of a line or a circle? Do they occur symmetrically on both sides or on one side?
- Body site: Where on the body is the skin change located?
- Additional complaints: Does the affected skin area itch, burn, hurt or bleed?
In most cases, the doctor can already tell during the physical examination whether it is a pathological skin thickening, and if so, which one.
Ultrasound
If necessary, the dermatologist measures the skin density and thickness with a special ultrasound device. For this purpose, the physician guides the device over the affected skin area. The ultrasound waves penetrate the skin and are reflected differently by the individual tissue structures. In this way, the physician can visualize skin structures down to a depth of 1 cm and assess skin thickness and density.
Other examinations
If necessary, the physician also examines the blood of the affected person. Among other things, the blood values provide indications of inflammation, allergy or other diseases. In some cases, a skin biopsy is useful. A small skin sample is taken under local anesthesia and then examined in the laboratory for malignant skin tumors. The biopsy also provides information about possible infections, autoimmune diseases or forms of allergy.
A skin smear is also useful to detect pathogens such as fungi or bacteria. The dermatologist removes some skin cells or secretion with a small brush, cotton swab or spatula. He then examines the sample under a microscope or has it analyzed in a laboratory.
How can elephant skin be prevented?
It is important to support the regeneration of healthy skin – regardless of possible causes or triggering underlying diseases. There are various options for prevention here:
Proper care against skin thickening
For your skin to remain supple and resistant, it needs moisture. In this way, the skin protects itself better against external influences, pressure and friction. To prevent pachyderma, it is therefore also advisable to use the appropriate care creams from the pharmacy (e.g. with urea or water-in-oil emulsions) after consulting your doctor or pharmacist.
Refrain from using conventional skin care products from the drugstore. They often contain softeners, preservatives and dyes, artificial fragrances or binders. These can stress, irritate and additionally dry out the skin.
Regular professional foot care also has a preventive effect against calluses.
Nutrition for thickened skin
As a matter of principle, make sure to support the health of your skin with the right diet. A balanced and varied diet with plenty of vegetables, fruit, cereals and fiber – and little meat and fish – is recommended.
