A condition characterized by abnormal thickening of the skin on the palms of the hands and soles of the feet

What is Keratoderma Palmaris et Plantaris?

Keratoderma Palmaris et Plantaris (KPP) refers to a group of skin disorders that cause abnormal thickening (hyperkeratosis) of the palmar skin (palms) and plantar skin (soles). This thickening can range from mild to severe and may involve dry, cracked, or callused skin. KPP can be either inherited (genetic) or acquired due to underlying medical conditions or environmental factors.

The condition can significantly affect comfort and mobility, especially when cracks become painful or infected.

What causes Keratoderma Palmaris et Plantaris?

KPP can have different causes:

Inherited (Hereditary) Forms:

• Caused by mutations in genes related to skin structure, particularly keratin production
• Inherited in autosomal dominant or recessive patterns
• Often starts in childhood or early adolescence

Acquired Forms:

• Linked to systemic diseases like:
  • Psoriasis
  • Eczema
  • Lichen planus
  • Syphilis
  • HIV infection
  • Certain cancers (paraneoplastic syndromes)
• Occupational exposure to irritants or friction
• Nutritional deficiencies (e.g., vitamin A or zinc)

Who is at risk?

• Individuals with a family history of palmoplantar keratoderma
• People with autoimmune, infectious, or metabolic diseases
• Those exposed to repeated friction or chemical irritants on hands or feet
• Children or adults with genetic skin disorders

What are the symptoms of Keratoderma Palmaris et Plantaris?

• Thickened, dry, and rough skin on the palms and soles
• Cracks or fissures, especially in severe cases
• Pain or discomfort, especially while walking or using hands
• Redness or inflammation
• In some hereditary types, associated with:
  • Nail abnormalities
  • Sweating disorders (hyperhidrosis)
  • Blistering (epidermolytic forms)

Symptoms can worsen with friction, pressure, or exposure to irritants.

Types of Keratoderma Palmaris et Plantaris

• Diffuse – affects the entire surface of palms and soles
• Focal – affects areas of high pressure (e.g., heels, balls of feet)
• Punctate – small, pinpoint areas of thickened skin
• Syndromic – associated with other symptoms (e.g., deafness, hair/nail defects)

How is Keratoderma Palmaris et Plantaris diagnosed?

Diagnosis is based on clinical evaluation, and may include:

• Detailed medical and family history
• Skin examination by a dermatologist
• Skin biopsy – to rule out other conditions or confirm hereditary types
• Blood tests – to identify underlying systemic diseases
• Genetic testing – in suspected inherited cases

How is Keratoderma Palmaris et Plantaris treated?

Treatment aims to reduce skin thickening, manage pain, and prevent complications.

Topical therapies:

• Emollients and moisturizers – to soften and hydrate the skin
• Keratolytic agents – salicylic acid, urea, or lactic acid to remove thick skin
• Topical retinoids – help regulate skin turnover
• Corticosteroids – reduce inflammation if needed
• Antibiotics or antiseptics – in case of secondary infection

Systemic treatments:

• Oral retinoids (e.g., acitretin or isotretinoin) – for severe or extensive cases, usually under specialist care
• Treating underlying conditions – like infections, autoimmune disorders, or nutritional deficiencies

Supportive measures:

• Regular foot soaks and debridement (done carefully or by a podiatrist)
• Use of soft, cushioned shoes and gloves to reduce pressure
• Avoidance of skin irritants and excessive friction

What is the prognosis for Keratoderma Palmaris et Plantaris?

• Hereditary forms are lifelong but can be managed with consistent treatment
• Acquired forms may improve significantly if the underlying cause is treated
• Proper skin care can greatly improve comfort and mobility
• Without treatment, painful cracks and recurrent infections may occur

Can Keratoderma Palmaris et Plantaris be prevented?

• Genetic forms cannot be prevented, but early diagnosis and treatment can reduce severity
• Acquired forms may be preventable by:
  • Avoiding skin trauma and irritants
  • Wearing protective gear when needed
  • Managing systemic diseases and nutrition
  • Maintaining good foot and hand hygiene