Palmoplantar Keratoderma: Symptoms, Treatments, and Diagnosis

Keratosis palmoplantaris (palmar-plantar keratoderma)

Hello Dr.
Wu, thank you for your response regarding my son's thick calluses two days ago.
You mentioned it is "palmoplantar keratoderma," but later I asked the doctor at the clinic, and they referred to it as "palmoplantar psoriasis." Are these two conditions the same? If a biopsy confirms it is "palmoplantar keratoderma," what effects can it have? What are the treatment options? Is it possible to fully recover? For the biopsy, it only requires local anesthesia, but he will still feel pain.
Will he have any sensation? Should we hold him tightly at that moment to facilitate the biopsy? I live in Yunlin, and is it feasible to have this detailed biopsy done at National Taiwan University Hospital in Huwei or Douliu? Or perhaps at Chiayi Chang Gung Memorial Hospital? I would appreciate your advice! Thank you! Thank you!

pinggu, 20~29 year old female. Ask Date: 2012/03/19

Dr. Wu Yuxin reply Dermatology

Palmoplantar keratoderma is a broad term that encompasses several dozen different phenotypes, some of which are hereditary and others acquired, with varying degrees of severity and prognosis, leading to different treatment approaches.
Local anesthesia can be painful when injected, but the primary concern is that children often have difficulty overcoming their fear.
If you reside in Yunlin, you can visit the Dermatology Department at National Taiwan University Hospital Yunlin Branch to discuss with a physician whether a biopsy is necessary.

Reply Date: 2012/03/19

More Info

Palmoplantar keratoderma (PPK) is a condition characterized by thickening of the skin on the palms of the hands and the soles of the feet. It can manifest in various forms and can be either inherited or acquired. Understanding the symptoms, diagnosis, and treatment options is essential for managing this condition effectively.

Symptoms
The primary symptom of palmoplantar keratoderma is the thickening of the skin, which can lead to the formation of calluses or plaques on the palms and soles. This thickening can cause discomfort, pain, and difficulty in walking or using the hands. Other symptoms may include:
- Cracking or fissuring of the skin, which can lead to secondary infections.

- Redness or inflammation around the thickened areas.

- Changes in skin texture, which may appear rough or scaly.

In some cases, PPK can be associated with other systemic conditions, such as palmoplantar pustulosis or ichthyosis, which may present additional symptoms.

Diagnosis
Diagnosis of palmoplantar keratoderma typically involves a thorough clinical examination by a dermatologist. A skin biopsy may be performed to confirm the diagnosis and rule out other conditions that may present similarly, such as psoriasis or eczema. The biopsy procedure usually involves local anesthesia, and while it may cause some discomfort, it is generally well-tolerated. The patient may feel pressure or a brief sting during the injection of the anesthetic, but the area will be numb during the procedure.

Treatment
Treatment for palmoplantar keratoderma focuses on managing symptoms and improving the quality of life. Options may include:
1. Topical Treatments: Keratolytic agents, such as salicylic acid or urea, can help to soften and reduce the thickened skin. Moisturizers are also crucial to keep the skin hydrated and prevent cracking.

2. Systemic Treatments: In cases where PPK is severe or associated with other systemic conditions, systemic medications such as retinoids or immunosuppressants may be prescribed.

3. Physical Therapy: For individuals experiencing pain or difficulty with mobility, physical therapy may be beneficial to improve function and reduce discomfort.

4. Surgical Options: In some cases, surgical intervention may be considered to remove particularly painful or bothersome areas of thickened skin.

Prognosis
The prognosis for palmoplantar keratoderma varies depending on the underlying cause and the severity of the condition. While some forms of PPK can be effectively managed with treatment, others may be more persistent and require ongoing care. It is important to have regular follow-ups with a dermatologist to monitor the condition and adjust treatment as necessary.

Recommendations for Care
If you are considering a biopsy or further evaluation, it is advisable to consult with a dermatologist who specializes in skin disorders. Facilities such as National Taiwan University Hospital or Chang Gung Memorial Hospital in Chiayi are reputable options for dermatological care. They can provide comprehensive evaluations and tailor treatment plans to your child's specific needs.

In summary, palmoplantar keratoderma is a manageable condition with various treatment options available. Early diagnosis and intervention can significantly improve outcomes and quality of life for affected individuals. If you have any further questions or concerns, do not hesitate to reach out to a healthcare professional for personalized advice and support.

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