Keratoderma is a skin disorder that leads to increased cornification. Also known as hyperkeratosis, this condition is where the top layer of skin thickens.
What is keratoderma?
In keratoderma, the outermost layer of the epidermis becomes horny. Depending on the disease, different areas of the body are affected by this cornification.
Human skin consists of different layers. The epidermis, also known as the epidermis, is the top layer of the skin. This layer serves to protect against environmental influences. The epidermis is also made up of different layers. These include the inner basal layer, stratum balase, the spinous layer, stratum spinosum, the granular layer, stratum granulosum, the gloss layer, stratum lucidum, and the outer horny layer, stratum corneum. See AbbreviationFinder for abbreviations related to Keratoderma.
The epidermis consists mainly of keratinocytes. These are cells that produce keratin. These cells keratinize as it moves from the lower layers to the top layer of the epidermis. In this case they are called corneocytes or corneocytes. The horny layer consists exclusively of corneocytes. The cells have died and form the stratum corneum.
If there is a disruption in the formation of this horny layer, this disease is referred to as keratoderma. This horny layer thickens in various parts of the body. These thickenings can occur in large areas or only occasionally in certain places.
Keratoderma refers to a group of diseases with the same symptoms. However, they are triggered by various causes. Hereditary palmoplantar keratoses are hereditary diseases. This group includes diseases such as diffuse or focal palmoplantar hyperkeratosis.
These two groups are in turn subdivided. Diffuse palmoplantar hyperkeratosis includes diseases such as Greither syndrome or click syndrome. Focal palmoplantar hyperkeratosis includes acrokeratoelastoidosis Costa and keratosis palmoplantaris striata. Follicular hyperkeratoses also belong 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 hereditary diseases. In addition to mutations, which are inherited, there can also be other causes of kerotoderma.
These include certain infections and increased UV exposure. However, mild forms of keratoderma can also occur. These manifest themselves in the form of calluses, especially on the hands and feet after heavy use. This is usually referred to as hyperkeratosis.
However, keratinization of the skin can also be triggered by other diseases such as psoriasis, ichthyosis or acne. The keratoderma comes about due to an increased cell proliferation in the epidermis or due to a reduced natural detachment of the horny layer.
Symptoms, Ailments & Signs
In keratoderma, the outermost layer of the epidermis becomes horny. Depending on the disease, different areas of the body are affected by this cornification. In the case of hereditary palmoplantar keratoses, cornification usually occurs on the hands and feet.
Follicular hyperkeratosis is a mild disease that only leads to minor keratinization of the skin. The affected person is only slightly impaired, since there is no disturbance in movement, which can occur with severe cornification. In erythrokeratoderma, keratinization and reddening of the skin occur. This reddening of the skin is also referred to as erythema and is caused by a local circulatory disorder.
Prokeratosis is manifested by the appearance of lesions and scales on the skin. These usually occur on the extremities as well as on the trunk and mucous membranes. Dyskeratotic-acantholytic keratoses are manifested by the appearance of cornifications on the body already in youth.
Diagnosis & course of disease
Diagnosis of keratoderma is made by examining the skin. The noticeable changes in the skin in the form of cornification, the increased formation of scales and redness can be recognized by a specialist. If the keratoderma is not treated, the affected areas may spread, depending on the type of keratoderma. In addition, the keratinization of the skin can progress until the patient is no longer able to move in the affected areas.
The keratoderma primarily causes severe discomfort, which mainly occurs on the patient’s skin. In many cases, this also leads to reduced self-esteem or inferiority complexes, since those affected no longer conduct themselves nicely. This disease can also lead to depression. The callus occurs mainly on the feet and hands.
As a rule, this does not result in any particular restrictions in movement or in everyday life. However, scales can also form on the skin, which affects the appearance of the affected person. Furthermore, it is not uncommon for blood circulation disorders to occur, so that extremities may appear cold. Treatment of keratoderma is most often carried out with the help of drugs and cosmetic procedures.
The symptoms can be limited relatively well, although the cosmetic procedures usually have to be repeated several times. Life expectancy is not changed or limited by the keratoderma. It is not uncommon for this disease to occur alongside other skin complaints, so that the other diseases can also lead to complications or complaints.
When should you go to the doctor?
Changes and abnormalities in the usual skin appearance should be examined and treated by a doctor. If the upper layer of skin on the feet becomes horny without any apparent reason, a doctor should be consulted if the person concerned does not achieve any improvements by helping themselves. In many cases, adequate foot care and wearing healthy footwear is sufficient to alleviate the existing symptoms. If, on the other hand, the symptoms spread further or if pain or misalignment of the feet occurs, a doctor should be consulted.
A visit to a doctor is advisable in the event of restricted mobility, incorrect hip or pelvic posture or impairment of normal physical performance. If you experience circulatory disorders, cold limbs, a general feeling of discomfort or a continuous decrease in the usual muscle strength in your legs, you need to see a doctor. Lesions, scaling of the upper layers of skin or reddening of the skin must be examined and treated. If mental and emotional irregularities develop in addition to the physical problems, a visit to the doctor is recommended.
If you are depressed, withdrawn, have intense feelings of shame or have behavioral problems, the risk of mental illness increases without adequate support. Prevention is necessary to ensure that there is no further reduction in well-being.
Treatment & Therapy
Depending on the severity, the keratoderma can be treated cosmetically with keratolytics. These are substances that soften and loosen the cornification. They induce keratolysis, a process in which the horny cells are detached from the epidermis. Retinoids such as isotretinoin or acitretin are effective keratolytics.
This also includes urae, urea, salicylic acid, alpha-hydroxy acids, azelaic acid and benzoyl peroxide. The hyperkeratosis softens and then has to be removed. This is done with the help of peelings, pumice stones or callus rasps. The keratoderma can also be treated hormonally, depending on the case.
Keratoderma can also occur as a side effect of other diseases. These are diseases such as dermatitis, scabies, Sézary syndrome, Reiter syndrome or reactive arthritis and human papillomaviruses. In such cases, the underlying condition must be treated to address the cause of the keratoderma.
Outlook & Forecast
A lighter form of keratoderma does not always require medical treatment. The cornifications that occur can usually be treated with keratolytics such as salicylic acid or uric acid, which have a horn-dissolving effect and reduce the horny layer. Baths are another option, after which the callus is removed using a corneal rasp or pumice stone. Special peelings or callus masks for the feet can also provide relief.
In everyday life, care must be taken not to irritate the skin unnecessarily and to prevent injuries. In contrast to silk fabrics, loose clothing made of linen and cotton does not stick to the callus and does not irritate the skin. If the weather conditions permit, open-toe shoes are advisable so that the skin can breathe and not too much pressure is exerted on it. It also avoids perspiration, 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 taken, a doctor must be contacted. He will check whether keratoderma is actually present or whether the symptoms are based on another disease and initiate appropriate therapy. As a rule, this involves hormone therapy with thyroxine supplemented with sufficient vitamin A.
Depending on the type of keratoderma disease, preventive measures can be taken. In the case of a slight keratoderma, which is caused by heavy stress on the skin, the cause of this stress can be avoided. An example of this is wearing unfavorable shoes, which can lead to hyperkeratosis on the feet.
There are no preventive measures for inherited forms of keratoderma. These forms have to be dealt with, but they keep recurring. In diseases associated with keratoderma, such as human papillomavirus infection, early treatment can prevent the development of keratoderma.
Follow-up care for keratoderma depends on the type of disease. If the symptoms are only mild, it is possible to alleviate the skin problems by reducing the stress. For example, calluses on the soles of the feet can be avoided if the patients wear more comfortable shoes.
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 softened.
This is followed by targeted treatment with a pumice stone or a corneal rasp. Successful aftercare can also be carried out with peeling products, which may be used together with soothing agents. 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, it is important to protect the skin areas. Otherwise there is a risk of complications or injuries. If parts of the body other than the feet are affected, doctors advise loose-fitting clothing. This does not irritate the sensitive skin and allows good air circulation. In order to rule out infections, patients should not rely solely on self-help measures, but should consult a doctor.
You can do that yourself
Keratoderma does not always require medical attention. In mild cases, the cornifications can be treated themselves with keratolytics such as salicylic acid, azelaic acid or benzoyl peroxide. The softened skin can then be removed with a callus rasp or a pumice stone. Peelings also loosen the skin and can be used in conjunction with a light sedative.
In severe cases, the keratoderma requires hormonal treatment. If the cornifications cannot be treated by the measures mentioned, a doctor must be consulted in any case. If the symptoms occur as a side effect of another illness, medical advice is also indicated. At the same time, the skin must be protected in order to avoid injuries and further complications. With a keratoderma on the foot, it is best to wear open-toe shoes. If other parts of the body are affected, loose clothing that does not irritate the skin is recommended. Cotton and linen are ideal. Clothing made of polyester should be worn during sports.
If the cornifications do not decrease despite all measures, medical advice must be obtained. In the case of injuries, reddening and other complaints, further self-help measures should be avoided.