A group of skin disorders characterized by thickening of the outer skin layer, usually on the palms and soles
What is Keratoderma?
Keratoderma refers to a group of skin conditions where there is abnormal thickening (hyperkeratosis) of the stratum corneum, the outermost layer of the skin. It most commonly affects the palms of the hands and soles of the feet, but it can occur in other areas.
Keratoderma may be inherited (genetic) or acquired due to other medical conditions or environmental exposures. Some forms are mild and cosmetic, while others can be painful and interfere with daily activities like walking or gripping.
What causes Keratoderma?
Keratoderma can be congenital (present at birth) or acquired later in life due to other health issues. Common causes include:
Inherited causes:
- Palmoplantar keratoderma (PPK) – a group of genetic disorders causing thick skin on palms/soles
- Vohwinkel syndrome, Mal de Meleda, Unna-Thost disease, and others
- Often linked to mutations in genes controlling skin cell growth and keratin production
Acquired causes:
- Repeated friction or pressure (e.g., from manual labor or walking barefoot)
- Chronic eczema or psoriasis
- Infections, especially fungal
- Systemic diseases such as:
- Lymphoma or leukemia
- HIV infection
- Arsenic poisoning
- Certain medications (e.g., chemotherapy drugs)
Who is at risk?
- People with a family history of keratoderma or genetic skin conditions
- Individuals with occupations involving frequent hand/foot use
- Patients with chronic skin inflammation or infections
- People with autoimmune or systemic illnesses
- Those exposed to chemicals or irritants over time
What are the symptoms of Keratoderma?
Symptoms vary depending on the type and cause but may include:
- Thickened, hardened skin on the palms or soles
- Yellowish or brown discoloration of the affected areas
- Dry, cracked, or scaly skin
- Pain or tenderness, especially while walking or using hands
- In severe cases: blistering, fissures, or secondary infections
Some inherited forms may also involve nail changes, hearing loss, or other systemic signs.
How is Keratoderma diagnosed?
Diagnosis is based on clinical evaluation and sometimes lab testing. Steps may include:
- Physical examination – of the skin, nails, and family history
- Skin biopsy – to examine the structure and rule out other causes
- Genetic testing – if an inherited form is suspected
- Blood tests – to check for infections, autoimmune diseases, or systemic illnesses
- Fungal culture – if an infection is suspected
How is Keratoderma treated?
Treatment depends on the underlying cause and severity:
General treatments:
- Emollients and moisturizers – to soften and hydrate the skin
- Keratolytic agents (e.g., salicylic acid, urea, lactic acid) – to help shed thickened skin
- Topical retinoids – to regulate skin growth in inherited forms
- Antibiotics or antifungals – if secondary infection is present
- Systemic medications (e.g., acitretin) – in severe or widespread cases
For acquired keratoderma:
- Treat the underlying disease (e.g., manage psoriasis, stop offending medications)
- Protective footwear and gloves to reduce friction and pressure
- Avoid harsh soaps and irritants
What is the prognosis for Keratoderma?
- Inherited forms are chronic and may require lifelong management but are generally non-life-threatening
- Acquired forms often improve once the underlying cause is treated
- With proper skin care, symptoms can be significantly reduced, improving comfort and function
- Severe cases may interfere with mobility or hand use, requiring more intensive therapy
Can Keratoderma be prevented?
While inherited forms cannot be prevented, you can reduce the risk or severity of acquired keratoderma by:
- Moisturizing regularly to prevent dryness
- Avoiding repeated trauma or friction to hands and feet
- Wearing protective gear in manual jobs
- Treating infections and skin conditions early
- Monitoring for systemic illnesses if keratoderma appears suddenly in adulthood