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Wyprysk z hiperkeratozą - Objawy, Diagnoza i Leczenie
Pathophysiology
The skin is composed of three layers: the epidermis, the dermis (composed of the superficial papillary and deeper reticular dermis), and the hypodermis. The skin has structural differences among the different areas of the body in terms of epidermal and dermal thickness, distribution of appendages, and pigmentation. The epidermis is composed of multiple layers of maturing keratinocytes: the basal layer (stratum basale), the squamous layer (stratum spinosum), the granular layer (stratum granulosum), and the cornified layer (stratum corneum). This stratified epithelium is in a constant process of self-renewing and exfoliation that takes 20-40 days to complete. The cells in the outer layer are the most differentiated in the keratinocyte line, composed almost entirely of keratin lamels of high molecular weight, and those are the ones that undergo desquamation, completing the maturation cycle.
When the epidermis is exposed to repetitive injury, it usually elicits an increased proliferative rate of the keratinocytes and accelerates their maturation. Keratinocytes also tend to produce more keratin, thus increasing the stratum corneum's thickness.
Genetic mutations resulting in hyperkeratosis is seen in ichthyoses and keratoderma. There are several damages in keratin-encoding genes such as KRT1 and KRT10, which cause defects in keratin structure. Defective keratin causes irregular aggregates of intermediate filaments, which leads to cellular collapse and blistering. The barrier function is then compromised, and the skin reacts with compensatory hyperproliferation, which leads to hyperkeratosis.
StatPearls [Internet].
Fabiola Farci , Gauri D. Mahabal .
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Last Update: September 4, 2023 .
Hyperkeratosis refers to the increased thickness of the stratum corneum, the outer layer of the skin. It is most frequently due to chronic physical or chemical damage such as friction or the use of aggressive soaps but can also derive from chronic inflammation or a side-effect of different drugs, including chemotherapy. This activity reviews the evaluation and treatment of hyperkeratosis and highlights the role of the interprofessional team in evaluating and treating patients with this condition.
Summarize the major histologic forms of hyperkeratosis. Review the different pathologies that can manifest with hyperkeratosis.Explain the importance of collaboration and communication amongst the interprofessional team to ensure the appropriate diagnosis and treatment is selected for patients with hyperkeratosis.
Treatment
Hyperkeratosis is, for the most part, highly manageable through various courses of treatment. The most effective treatment options for the varied types of hyperkeratosis include:
- Keratolytics are designed to break down the outer layer of thick skin.
- Moisturizers help combat dry and rough skin.
- Corticosteroids can reduce inflammation.
- Retinoids are designed to encourage a more regulated level of skin cell growth.
That said, each type will have its own treatments. They can include:
When to Call a Healthcare Provider
Make an appointment with your healthcare provider to discuss symptoms and treatment. Your provider will investigate your condition and advise you on which treatment will work best for you. In some cases, treatment is unnecessary.
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.
Hiperkeratoza podpaznokciowa
Jedną z odmian hiperkeratozy jest hiperkeratoza podpaznokciowa. Stanowi ona bardzo częsty objaw łuszczycy paznokci, dlatego, aby nie dopuścić do rozwoju poważniejszego schorzenia, należy jak najszybciej podjąć z nią walkę. Pod paznokciem, zazwyczaj w wyniku niedostatków w zakresie higieny, gromadzą się komórki, które powinny zostać usunięte. Zajęta procesem chorobowym część paznokcia przyjmuje białe zabarwienie i następuje stopniowe oddzielanie się płytki od palca.
Z hiperkeratozą zmagają się nieraz także ludzie, których dotykają bardzo poważne przypadłości. Jedną z nich jest posiadanie stomii, czyli sztucznego ujścia dla produktów przemiany materii, które zastępuje układ wydalniczy. Hiperkeratoza może wystąpić wokół stomii jako efekt nieprawidłowej pielęgnacji i naprzemiennych biegunek i zaparć, a także w wyniku uczuleń na preparaty ochronne. Dlatego istotna jest bardzo dokładna pielęgnacja tej okolicy i dobór odpowiednich kosmetyków.