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Wyprysk z hiperkeratozą - Objawy, Diagnoza i Leczenie
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.
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.
Lokalizacje odcisku:
- palce stóp (okolica grzbietowa stawy międzypaliczkowe, boczna i przyśrodkowa powierzchnia palców w miejscu stykania się skóry Clavus mollis, okolica podeszwowa palca – Clavus appex)
- przodostopie (głowy kości śródstopia)
- wały paznokciowe (clavus sulcus)
- przestrzenie podpaznokciowe (clavus subungualis)
Clavus durus (Cd) – zbudowany jest ze zwartej i twardej masy ułożonej warstwowo (nawet do 200 warstw), zawierający jądro.
Clavus mollis (Cm) – to inaczej odcisk miekki.
Clavus vascularis (Cv) – to odcisk z zawartością drobnych naczyń krwionośnych.
Clavus neurovascularis (Cnv) – odcisk nerwowo – naczyniowy.
Clavus neurofibrosis (Cnf) – odcisk nerwowo – włóknisty.
Clavus papilaris (Cp) – to odcisk brodawkowy. Często się powtarza.
Clavi miliares (Cmil) – odciski mnogie.
Introduction
Hyperkeratosis refers to the increased thickness of the stratum corneum, the outer layer of the skin. Stratum corneum is composed of multiple layers of keratinocyte bodies that, during maturation, produced keratin and subsequently have lost their nucleus and cytoplasmic organelles. The result is a basketweave appearance of anucleate keratinocytes that protect the underlying cells during maturation.
Hyperkeratosis is subclassified as orthokeratotic or parakeratotic. Orthokeratotic hyperkeratosis refers to the thickening of the keratin layer with preserved keratinocyte maturation, while parakeratotic hyperkeratosis shows retained nuclei as a sign of delayed maturation of keratinocytes. Hyperkeratosis can be associated with dyskeratosis. It represents a premature (keratinocytes that are located below the granular cell layer) or abnormal keratinization of individual keratinocytes.
Hyperkeratosis, associated with other abnormalities in the skin biopsy, can be a key to the final histological diagnosis. Epidermal hypertrophy is a benign alteration of the skin that presents with acanthosis (increased thickness of the keratinocyte layers) and hyperkeratosis.
