ACQUIRED PALMOPLANTAR KERATODERMA PDF

Metrics details Abstract Palmoplantar keratodermas PPKs are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task. To facilitate such evaluations, this review categorizes the acquired PPKs as: keratoderma climactericum, drug related, malnutrition associated, chemically induced, systemic disease related, malignancy associated, dermatoses related, infectious, and idiopathic. In order to avoid the possibility of overlooking an underlying etiology and to eliminate excessive testing, we present an algorithm for assessing patients presenting with acquired PPK. The first step should include a comprehensive history and a physical examination, including a complete skin examination. If findings are consistent with a hereditary keratoderma, then a genetics consultation should be considered.

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Most varieties of this condition are congenital—and usually inherited—although there are acquired forms as well. All varieties of palmoplantar keratoderma can affect both the hands and the feet, but focal palmoplantar keratoderma tends mostly to affect the skin on the bottom of the foot.

Symptoms of Palmoplantar Keratoderma That Develop People who suffer from this condition have abnormally thick skin on the soles of their feet and palms of their hands. This thickening of the skin begins to develop in early childhood, usually around the time the affected child learns how to walk.

The affected skin acquires a reddish, flaky appearance and eventually hardens into thick, yellowish pads of callus. Depending on which type of keratoderma the person suffers from, it can affect the entire sole of the foot or it may appear in streaks or patches, possibly mimicking the appearance of corns. There is also an extremely rare genetic mutation that causes a combination of disorders known as palmoplantar keratoderma with deafness.

Children affected by this condition develop hearing loss, particularly for high-pitched sounds, at around the same time the skin on their soles and palms begins to thicken. Fortunately, this genetic condition is rare, and has only been identified in ten families.

In rare cases, abnormalities of the toenails may develop. The combination of these difficulties with the aesthetically undesirable appearance of the feet can lead to psychological and emotional problems, particularly in children.

In general, the cause of this condition is abnormal genes that cause the body to incorrectly manufacture certain keratin proteins necessary for strong, resilient skin, hair, and nail tissue. These proteins fail to form networks within the skin cells, making those cells fragile. These easily damaged cells are less resistant to the minor trauma that results from the ordinary friction that occurs when we stand or walk.

There are three general classifications of palmoplantar keratoderma: Focal: With this condition, the keratoderma appears at pressure points, i. Punctate: With this form of palmoplantar keratoderma, numerous small nodules appear all over the soles. This condition tends to cause more pain in weight-bearing parts of the foot. Acquired Palmoplantar Keratoderma While palmoplantar keratoderma is in most cases a genetic condition, there are situations in which it can be acquired, usually as a symptom of some inflammatory skin condition, such as psoriasis, eczema, ichthyosis, scabies, or dermatitis.

The Diagnosis, Treatment, and Prognosis Of Palmoplantar Keratoderma Diagnosis of palmoplantar keratoderma will usually be made by the age of two or three. Treatment options, unfortunately, are somewhat limited.

Debridement of the skin—for example, if an individual attempts to deal with the problem without medical intervention by getting a pedicure —may in some cases make the problem worse. While the problem cannot be cured, the symptoms can generally be mitigated, although affected individuals can expect to have to manage their condition throughout their lives. Prescription or over-the-counter antifungal creams may help with foot odor and other symptoms of fungal infection, and regular application of moisturizing creams can slow the formation of calluses.

In rare cases a doctor might prescribe a drug known as acitretin, which thins the affected skin. ISBN

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Palmoplantar keratoderma

Most varieties of this condition are congenital—and usually inherited—although there are acquired forms as well. All varieties of palmoplantar keratoderma can affect both the hands and the feet, but focal palmoplantar keratoderma tends mostly to affect the skin on the bottom of the foot. Symptoms of Palmoplantar Keratoderma That Develop People who suffer from this condition have abnormally thick skin on the soles of their feet and palms of their hands. This thickening of the skin begins to develop in early childhood, usually around the time the affected child learns how to walk. The affected skin acquires a reddish, flaky appearance and eventually hardens into thick, yellowish pads of callus. Depending on which type of keratoderma the person suffers from, it can affect the entire sole of the foot or it may appear in streaks or patches, possibly mimicking the appearance of corns.

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Acquired palmoplantar keratoderma.

Aetiology Keratoderma is usually acquired, but can be inherited as an autosomal dominant or autosomal recessive pattern The feet are generally more severely affected than the hands. Occasionally keratoderma can affect other parts of the body It can be difficult to differentiate between the different types of keratoderma, however, the management principles are similar, and as such the key diagnostic elements are to exclude the rare malignant or other systemic causes Clinical findings Keratoderma can be defined by its clinical appearance, although there is often overlap: Diffuse - the whole of the palmar or plantar skin Focal - the pressure points are more severely affected eg heel margins and either side of the metatarsal arch Punctate keratoderma - multiple small scattered lesions Striate - longitudinal involvement, especially along the fingers Logical approach to management Keratoderma may be hereditary, with symptoms presenting in early childhood, or acquired when it presents in later life. Rarely keratoderma can be associated with malignancy. Hereditary keratoderma Diffuse keratoderma Several inherited forms have been described, most being autosomal dominant, although some are autosomal recessive. There is usually a well-defined erythematous border The two conditions vary in their histological features Several others types have been described. Some people with focal palmoplantar keratoderma also have abnormalities of the fingernails and toenails There are several inherited types, which are all rare.

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