Palmoplantar Keratoderma: Treatment, Cost and Side Effects

Palmoplantar keratoderma refers to a group of skin ailments that cause the skin of the palms and soles to thicken and harden. In some rare types of palmoplantar keratoderma, organs other than the skin may also thicken and harden. The condition is commonly acquired due to environmental factors, changes in a person’s health, or due to certain underlying diseases. It is sometimes caused by genetic mutations causing abnormalities in keratin protein. If caused due to genetic mutation, the condition is heritable by autosomal dominant or autosomal recessive inheritance.

Acquired palmoplantar ketoderma can be caused by a number of factors, including menopause, long term mechanical friction, diseases like thyroid conditions, skin diseases like psoriasis, infectious diseases like syphilis, etc. The condition causes the skin to become hard and thick and sometimes develop a yellowish tinge. Depending on the location and extent of the hardening, palmoplantar ketoderma can be diffuse, where the entire palm or sole becomes hardened, focal, where only the points of mechanical friction hardens, punctuate, where small spots on the palms or soles become hardened, or rarely transgradient, where the hardened skin extends onto the backs of the hands or feet.

Treatment for acquired palmoplantar ketoderma involves treating the underlying cause which subsequently eliminates the hardening of the skin. Genetic palmoplantar ketoderma cannot be treated completely, and only its symptoms are managed.

Treatment for inherited palmoplantar ketoderma involves managing the symptoms when they appear. The treatment procedures include soaking with saltwater, cutting off the hardened outer layers of skin, topical ointments containing keratolytics to break down abnormal keratin deposits, topical retinoids and Vitamin D to stimulate skin growth, topical steroidal ointments, or surgical skin removal and grafting. Treatment for acquired palmoplantar keratoderma involves treating the underlying causes of the condition along with the specific symptoms of keratoderma. Curing the underlying condition also removes the symptoms of keratoderma.

Palmoplantar keratoderma causes the skin on the palms and soles to thicken and harden either in localized spots, or the entire palm or sole. Treatment is required if the condition significantly affects day to day activities due to a heavy buildup of hardened tissues.

Treatment is usually not required if the condition does not significantly impact day to day life. In some cases, palmoplantar keratoderma may actually be beneficial, for example in musicians playing stringed instruments like the guitar, where the hardening of skin on the fingertips helps to play the instrument. This does not require treatment.

Some side effects may be associated with treatment for palmoplantar keratoderma. Cutting off the hardened skin may cause abnormal growth of the skin subsequently. Some chances of bleeding and infection also exist with skin cutting treatments.

Post treatment guidelines for acquired palmoplantar ketoderma include keeping the skin of the palms and soles moist and soft by applying topical ointments, avoiding excessive mechanical friction or pressure on the palms and soles, etc. Inherited forms do not have any specific post treatment guidelines.

Complete recovery does not occur for inherited forms of palmoplantar ketoderma. Acquired forms are cured once the underlying condition is treated.

Cost of treatment for palmoplantar keratoderma usually ranges between Rs. 500 and Rs. 10,000, and may go up higher for long term treatments or development of complications.

Results of the treatment are not permanent and treatment needs to be undergone at regular intervals to manage the symptoms.

A number of alternative treatments are available to treat the condition. These include traditional medications, home remedies, and herbal preparations for topical application or ingesting orally.