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.

Types of Hyperkeratosis

"Hyperkeratosis" is an umbrella term for skin conditions that develop from excess amounts of keratin. There are various types of hyperkeratosis, each marked by its cause.

Hereditary Types of Hyperkeratosis

Some types of hyperkeratosis develop due to a hereditary component. Examples include:

• Epidermolytic hyperkeratosis
• Multiple minute digitate hyperkeratosis (MMDH)
• Focal acral hyperkeratosis
• Lamellar ichthyosis
• X-linked ichthyosis (XLI)
• Keratosis pilaris, otherwise known as follicular hyperkeratosis

Acquired Hyperkeratosis

Other forms of hyperkeratosis are acquired later in life. It’s not always clear what the cause of each type is. Some acquired hyperkeratosis conditions include:

Acquired vs. Hereditary

Hereditary conditions are passed down through families. Often if a person is related by blood to someone with a genetic disorder, their risk of getting it is a lot higher. Acquired conditions, on the other hand, develop for many reasons unrelated to genetics.

Lokalizacje modzeli:

• palce stóp (okolica grzbietowa i podeszwowa oraz boczna)
• pięta
• przodostopie
• boczna krawędź stopy

ODCISK

BRODAWKA WIRUSOWA

Często występują u dzieci

Dr n.med. Danuta Nowicka ”Dermatologia. Ilustrowany podręcznik dla kosmetologów”, Wrocław 2014

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.

A Word From Verywell

A skin condition can be challenging to deal with, especially if it causes painful symptoms. The good news is that dealing with most forms of hyperkeratosis is manageable with the proper treatment. In most cases, this condition is not severe or life-threatening.

The best thing you can do if you have hyperkeratosis is to speak to a dermatologist (a medical doctor specializing in conditions of the skin, hair, and nails) about your condition and any concerns you have. They will be able to determine the next steps to address your condition.

Frequently Asked Questions

The treatment for hyperkeratosis will depend entirely on its type and the underlying cause. Treatment isn't always necessary because some forms of hyperkeratosis are either asymptomatic or present with mild cosmetic symptoms. The most common forms of treatment include keratolytics, moisturizers, emollients, and retinoids.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Jakeman A. The effective management of hyperkeratosis.Wounds Int. 2012,1:65-73.
2. National Human Genome Research Institute. Genetic disorders.
3. Tian Y, Li XX, Zhang JJ, Yun Q, Zhang S, Yu JY, Feng XJ, Xia AT, Kang Y, Huang F, Wan F. Clinical outcomes and 5-year follow-up results of keratosis pilaris treated by a high concentration of glycolic acid.World J Clin Cases. 2021 Jun 26,9(18):4681-4689. doi:10.12998/wjcc.v9.i18.4681
4. Harvard Health Publishing Harvard Medical School. Hyperkeratosis.
5. National Organization for Rare Disorders. Lamellar Ichthyosis.

By Angelica Bottaro
Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.

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