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Wyprysk z hiperkeratozą - Objawy, Diagnoza i Leczenie
History and Physical
Hyperkeratosis is a histopathological term defining a thickened stratum corneum and may be present in many different skin conditions, with many possible overlaps. History and clinical evaluation are key, and the main goal is to collect as much information as possible and discern which cases require a histopathological diagnosis to direct the most appropriate treatment.
The history comprises the age of the patient, family history, exposure to toxic substances, drugs, occupational duties, anamnesis of the current lesion, concomitant pathologies, and treatments. In those patients where the diagnosis was already established, it is appropriate to reevaluate it, monitor progression and complications following the treatment.
The physical examination must be thorough to exactly understand the extent of the disease. Except for localized disease, it is important to inspect the entire skin surface, including scalp, eyelids, ears, perineum and genital mucosa, hair, and nails. The lesion should be described in terms of color, texture, shape, and distribution. Surrounding skin should be examined as well to detect the presence of generalized xerosis (dryness), seborrhea, hyper or hypohidrosis (sweating), texture, photoaging such as lentigines, actinic purpura, rhytides.
Small folliculocentric keratotic nodules can be found in cases of keratosis pilaris, where papules are centered on small hair follicles, and it can be associated with erythema. On close examination, it is possible to recognize a small coiled hair beneath the papule formed by a keratin plug.
Scaling is an important finding in cases of hyperkeratosis. Scales may be described as soft, rough, greyish, bran-like, and so on. Crusts should not be confused with scale as it is the result of dried fluid on the epidermis (serum, blood, pus, or a combination of those) and not thickening of the epidermis. Lichenification is a thickening of the skin and results from chronic injuries such as repetitive scratching. It is present in most chronic eczematous or neurogenic processes.
ROGOWIEC
Choroba genetyczna cechująca się hyperkeratynizacją skóry i paznokci. Jest to pogrubienie ograniczone do powierzchni dłoniowych i podeszwowych, pojawiające się zwykle z powodu mutacji.
GŁÓWNE OBJAWY ROGOWCA:
- nadmiernie zrogowaciały naskórek
- żółte lub woskowe zabarwienie skóry
- zgrubiałe i przerosłe płytki paznokciowe
Odmiany rogowca
Unna-Thost pojawia się ok. 1-2 roku życia. Zmiany rogowe są symetryczne, występuje nadpotliwość dłoni i stóp.
Keratoma disseminatum pojawia się po 20 roku życia. Charakteryzuje się drobnymi, rozsianymi wykwitami. Z wiekiem może ich przybywać.
Keratoma trnsgrediens et progrediens pojawia się w pierwszych miesiącach życia. Ogniska hyperkeratotyczne występują poza dłońmi i stopami i najczęściej znajduję się na łokciach i kolanach.
Toxicokinetics
BCR-ABL inhibitors (mainly nilotinib and dasatinib) are commonly used for ontological target therapy, and the cutaneous side effects are only second to the hematologic sequelae. They are usually transitory and not severe. The most common dermatological side effect is a pruritic skin rash, while chronic dermatological side effects include psoriasis, lichenoid hyperkeratosis, pityriasis, and others.[14][15][16]
Multikinase-inhibitors (VEGF, PDGFR, EGFR, KIT, RET, Flt3, and RAF) affect the skin homeostasis and give rise to many different cutaneous manifestations, mainly with hyperkeratosis in the form of hyperkeratotic hand-foot skin reaction.[14] Hyperkeratosis occurs in the sites of friction or pressure, mainly soles, causing pain and limitation of the daily activities.[17][18]
Treatment / Management
Basic skincare measures are important to prevent excessive dryness and to encourage exfoliation. Those remedies include soaps with skin-specific pH, soap-free cleansers, and avoidance of hot baths. Emollients and topical keratolytic agents (lactic acid, salicylic acid, urea) should be advised to be applied over affected areas at the appropriate times.
Surgical procedures have limited relevance in the treatment of hyperkeratosis. In cases of untreatable plantar keratosis with significant daily limitation, skin grafts with rotation skin flap have been demonstrated effective.[25][26]
Corticosteroids are the treatment of choice for inflammation-driven diseases such as lichen planus or psoriasis. Topical application is the best choice for localized disease. Topical applications should last one to two weeks.
Immunosuppressant or immunomodulators (cyclosporin, hydroxychloroquine, mycophenolate mofetil, sulfasalazine, alefacept, efalizumab) can be used in severe recurrent cases.
Topical calcineurin inhibitors (tacrolimus or pimecrolimus) can also be used.
Retinoids, topical or oral-based, are used in disorders of keratinization such as ichthyoses, keratosis folliculitis, and psoriasis. Topical administration is variable and must be evaluated in the appropriate clinical context, treatment usually lasts 8 to 12 weeks.
Combination treatments with lasers (e.g., pulsed-dye laser, 755-nm alexandrite laser, 810-nm diode laser, 1064-nm Nd:YAG laser) and microdermabrasion are noninvasive techniques currently under approval for different hyperkeratotic diseases.
Jakie są przyczyny hiperkeratozy?
Przyczyny hiperkeratozy mogą mieć różnorodne podłoże. Należą do nich:
- tarcie i ucisk,
- problemy hormonalne,
- reumatyzm,
- cukrzyca,
- nadwaga,
- reakcje uczuleniowe,
- niedobory witamin,
- kontakt z silnymi środkami chemicznymi (np. detergentami),
- zbyt sucha skóra,
- dziedziczne choroby genetyczne, np. rybia łuska,
- łuszczyca,
- atopowe zapalenie skóry,
- podrażnienia mechaniczne,
- infekcje grzybicze i bakteryjne.
W przypadku hiperkeratozy na stopach do przyczyn zalicza się również:
- źle dobrane obuwie,
- zdeformowaną budowę stopy,
- konieczność stania przez długi czas,
- długie spacery i marsze,
- biegi długodystansowe,
- zbyt dużą potliwość stóp,
- brak odpowiedniej higieny stóp.