Palmoplantar Keratoderma - Causes and Treatment

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.

Causes:

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.

Treatment:

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.

For more information consult a skin disorder specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/skin-disorders