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Wyprysk z hiperkeratozą - Objawy, Diagnoza i Leczenie
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.
Evaluation
Dermoscopy is noninvasive and allows visualization of the skin structures in the epidermis, dermo-epidermal junction, and superficial dermis.
A biopsy is essential in cases in which the clinical setting is overlapping with different entities having distinctive histopathologic findings. For an ideal full-thickness biopsy, it is important to include the hypodermis. This can be performed with a simple 3 mm punch that minimizes scarring in the affected area. Any smaller size is at risk of being non-diagnostic.
Patch tests can be useful for identifying the causative allergen if an allergic dermatitis is suspected. Clinical clues are the presence of persistent, pruritic, eczematous eruptions in which any other identifiable cause has been excluded. If the patient tests positive, they should be encouraged to avoid the specific allergen. A follow-up after a few weeks of allergen avoidance is strongly recommended.
Narzędzia i środki stosowane w podologii w procesie usuwania hyperkeratoz:
- frezarka
- dłuta i skalpele
- pilniki kątowe
- frezy diamentowe oraz pokrywane węglikiem spiekanym
- inne frezy ścierne (kapki)
- preparaty zmiękczające do zastosowań profesjonalnych (płyny, żele, pianki)
- preparaty pielęgnacyjne (gabinetowe i do pielęgnacji domowej)
- opatrunki
- ortozy i odciążenia gotowe oraz indywidualne
- systematyczne wizyty w gabinecie podologicznym
- dobór właściwego obuwia i/lub wkładek
- przestrzeganie zaleceń specjalisty
- właściwa pielęgnacja domowa – stosowanie zaleconych kosmetyków oraz unikanie samodzielnych „operacji”
- leczenie schorzeń współistniejących
Coping
Coping with a skin condition like hyperkeratosis isn’t always easy because of physical and cosmetic symptoms. However, with the proper treatment, you will be able to manage your symptoms and improve the visual appearance of your skin.
"Hyperkeratosis" is a blanket term used to describe various skin conditions. The health conditions associated with hyperkeratosis have different symptoms. However, they one thing in common: the excess production of keratin.
Hyperkeratosis can be hereditary and passed down through families, but it can also develop later in life because of different factors. Some forms of the condition have no known cause.
Hyperkeratosis may take time to diagnose. Work with your healthcare provider to determine the underlying cause of your skin condition. Once that is done, you can begin the proper treatment to manage your skin condition.
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.