Causes and risk factors:
As the name suggests, acquired keratoderma is caused due to certain underlying disease of causative factor. The acquired form can be caused due to variety of factors. Various skin affections like psoriasis, eczema, dermatitis contribute to the causation. It can also occur as a side effect of certain medications or on exposure to harmful substance like iodine, lithium, arsenic, etc.; infections like syphilis, scabies, and Reiter syndrome can also lead to keratoderma. Apart from skin diseases and infections, certain systemic causes too contribute to the causation. The major ones are myxedema or various malignancies like skin cancer or any other internal organ cancer. Studies have shown that keratoderma climactericum seems to particularly develop in postmenopausal women of middle age.
Thickening and scaling of the skin can also be seen secondary to various inherited diseases like epidermolysis bullosa, ichthyosis, etc.
Clinical presentation:
Acquired palmoplantar keratoderma can be diffuse, focal, or punctate type. Thickening and scaling of the skin of the palms and soles is the important feature seen. Scaling gives a whitish appearance to the skin while thickening can lead to yellowish crust formation on the affected skin. The lesions can either be diffuse where the entire sole and palms are involved or it can be seen particularly at the pressure areas. This gives either a rough or shiny texture to the affected area. Besides these it does not lead to any subjective complaints; however, it does hamper the cosmetic appearance which can lead to social embarrassment.
Investigations:
A complete history of the patient is taken into consideration. Along with this, examination of the palms and soles is done. Certain investigations are advised as per the presentation of the patient and the history. If the history suggests any underlying causes, then investigations to find out the underlying cause are advised.
Treatment:
Treating the underlying cause is the main line of treatment. The conservative modes of treatment consist of administration of topical keratolytics or topical retinoids or corticosteroids are advised. Soothing emollients or moisturizers can also be advised. Topical psoralen plus UVA are also found to be effective in the treatment. Physical debridement of the tissues can be done.
When to contact a doctor:
Contact a dermatologist if one notices scaling or thickening of the skin on the palms and sole.
System involved: Integumentary system.
Organ involved: Skin, tissues, palms. and soles.
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