Palmoplantar Keratoderma - Causes and Treatment
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Palmoplantar Keratoderma - Causes and Treatment

Published on Mar 17, 2017 and last reviewed on Aug 02, 2023   -  2 min read


Palmoplantar keratoderma is an autosomal recessive disorder, which results in abnormal thickening of the skin on the palms and soles. read the article to know more.

Palmoplantar Keratoderma - Causes and Treatment

What is Palmoplantar Keratoderma?

Palmoplantar keratoderma is a commonly encountered problem in day to day practice. This disease presents as a distressing thickened skin with fissured pattern, intermingled with recurrent eczema like flare up.

What Causes Palmoplantar Keratoderma?

The causes could be either.

  1. Exogenous or external factors like irritants, allergens, infections, etc.

  2. Endogenous factors or internal factors like atopic dermatitis, pompholyx, psoriasis, etc.

How Is Palmoplantar Keratoderma Treated?


Primary treatment includes measures for correcting the underlying cause, by using antipsoriatic agents, antifungal agents, avoiding irritants (like detergent, hard soap or cleanser) or allergens.

Associated fungal or bacterial infections, dermatitis, and hyperhidrosis (excessive sweating of palms and soles) should be treated adequately. Symptomatic measures like antihistaminic or painkillers may be required in painful fissures.

Due to thickening of the skin in this condition, topical medicines have limited effect. But, their absorption can be increased by using occlusive dressing. Scrubbers or pumice stones used during manicure and pedicure also serve a similar function.

Use of properly fitted footwear and socks can prevent fissuring of the sole, by protecting them from environmental insults and providing occlusive effects.

In mild cases (localized or diffuse keratoderma), moisturizer with a barrier cream can be used. Soak the affected part in sodium chloride for 10 to 15 minutes, and it will help in softening the skin, which can be quickly scrubbed. Keratolytic agents like Dithranol, Coal tar, Tretinoin, Tazarotene are helpful.

In moderate cases (extensive keratoderma with few superficial fissures), topical steroids like Mometasone and UVA are useful.

In severe cases (extensive keratoderma with multiple deep fissured which bleed), use topical high potent steroids like Halometasone, Clobetasol, etc. and PUVA (Phototherapy). Systemic steroids, retinoids, cytotoxics like Methotrexate, Azathioprine, and Cyclosporin A must be considered.

All topical agents should preferably be in an ointment base, provide occlusion with the application of polythene sheet over the applied cream, it helps in better active drug penetration and produces beneficial results. In the absence of cutaneous irritants or deep fissures, keratolytic agents should be used first, followed by other drugs, yields better results.

  • Since cumulative insult dermatitis or allergic contact dermatitis is common, simple measures like repeated application of cooking oil, prove useful to maintain beneficial effects by fastening the absorption of specific topical medicines.
  • Systemic medication like steroids (Prednisolone, Deflazacort, etc.), retinoids (Acitretin), etc. are used only in severe cases, because of their dependency and toxicity.

As most of these conditions are recalcitrant, a combination treatment is most effective and should be gradually worked up, starting from mildest to the drastic measures.

Frequently Asked Questions


Can Palmoplantar Keratoderma Be Cured?

Palmoplantar keratoderma, an inherited condition, cannot be cured, but its symptoms can be controlled. Individuals who have keratoderma also undergo stress due to the appearance of their skin, which affects their mental health.


Can Palmoplantar Keratoderma Spread From One Person to Another?

An autosomal recessive inheritance can transmit the palmoplantar keratoderma. But, it is not contagious or infectious.


What Do You Mean by Acquired Keratoderma?

Acquired keratoderma is the keratoderma which is not inherited. It is usually acquired by a generalized skin condition or by another illness.


What Do You Mean by Keratosis Punctata?

Keratosis punctata is a rare disorder that commonly occurs in the skin of black people. In this, the lesion will have 1 to 5 mm of depression, which is filled with a comedo-like keratinous plug in the palms of the hands and soles of the feet.


How Do You Treat Palmoplantar Keratoderma?

Treatment aims to reduce the thickness of the skin and softening the skin. Treatment options include regular use of saltwater soaks, emollients, topical keratolytic such as urea or salicylic acid, antifungal tablets or creams if indicated, topical retinoids, Calcipotriol, systemic retinoids, skin grafting, and topical steroids.


How to Cure Palmoplantar Psoriasis?

Palmoplantar psoriasis is a long-term condition, and it cannot be cured, but the symptoms can be controlled. They can be treated with:
- Topical steroids with a vinyl dressing or sterile bandage.
- Coal tar ointment to heal the blisters and make them less itchy.
- Phototherapy or PUVA.
- Acitretin tablets, which are made from vitamin A.


What Diet Should You Follow in Palmoplantar Keratoderma?

The diet to be followed in palmoplantar keratosis is to avoid all spicy and salty foods, which can ease psoriasis symptoms.


What Is the Differential Diagnosis for Palmoplantar Keratoderma?

The differential diagnosis for palmoplantar keratoderma are:
- Tinea pedis.
- Psoriasis.
- Contact dermatitis.
- Reactive arthritis.
- Atopic dermatitis.
- Acrokeratosis paraneoplastic.
- Arsenical keratosis.
- Acanthosis nigricans.
- Acquired ichthyosis.
- Cutaneous T-cell lymphoma.
- Lymphedema.


What Surgery Can Be Done for Palmoplantar Keratoderma?

The surgical treatment for palmoplantar keratoderma includes full-thickness excision of the hyperkeratotic plaques, followed by skin grafting.


Is Palmoplantar Keratoderma associated with Lung Cancer?

Palmoplantar keratoderma is a congenital or acquired disorder characterized by abnormal thickening of the skin of the sole and palm. The thickening can be present in focal, diffuse, or punctate patterns. It can have internal malignancies that affect esophageal and lung carcinomas. Therefore, palmoplantar keratoderma can cause lung cancer.


Can Palmoplantar Keratoderma Affect the Feet?

Palmoplantar keratoderma can affect the feet because it is a disorder characterized by skin abnormalities. The individual may develop thickened skin in the palm and sole of the feet.

Article Resources

Last reviewed at:
02 Aug 2023  -  2 min read




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