Keratoderma

Keratoderma refers to a group of disorders characterized by thickening and roughening of the skin’s stratum corneum. The most common presentation is palmoplantar keratoderma, with hard, scaly, fissured skin on the palms and soles. In some cases keratoderma is localized, generalized, or presents as punctate plaques.

Many hereditary forms are autosomal dominant, though recessive patterns occur. They are categorized by distribution (diffuse, focal, punctate) and age of onset, with a spectrum from mild to severe. Mutations in keratin and other skin-structure genes underlie several subtypes. Acquired keratoderma can result from chronic friction, inflammatory dermatoses, infections, nutritional deficits, drugs, arsenic exposure, or paraneoplastic syndromes.

Clinical features include thickened, calloused palms and soles, often with painful fissures that hinder walking or grip. Some hereditary forms spread to additional surfaces (transgredients), and certain subtypes have characteristic patterns of involvement.

Diagnosis is primarily clinical and supported by histology showing hyperkeratosis; genetic testing may confirm hereditary forms and aid counseling. Evaluation for underlying causes is essential in acquired cases.

Management focuses on reducing thickness and discomfort. Treatments include regular emollients, keratolytics such as salicylic acid or urea, and topical steroids for inflammation. Severe cases may require systemic retinoids, mechanical debridement, or specialized footwear; addressing associated conditions is also important.

The prognosis varies by type and severity. Hereditary keratodermas are generally lifelong, requiring ongoing management to maintain function and quality of life.