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Wyprysk z hiperkeratozą - Objawy, Diagnoza i Leczenie
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.
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]
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.