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hyperkeratosis

Hyperkeratosis

Hyperkeratosis and Lymphedema

One of the complications of long term lymphedema is a condition referred to as hyperkeratosis and is usually found in leg lymphedema versus arm lymphedema. Hyperkeratosis is a condition where in the body produces excessive protein called Keratin, resulting in the thickening of the skin. The hyperkeratosis associated with lymphedema also is a thickening of the skin layers due to increased fibrosis. and is more common in late stage two or stage three.

Prevention of Hyperkeratosis

In lymphedema, hyperkeratosis can be prevented or delayed with a proper self care mangement program. This program includes skin care, daily use of lotions, compression wrapping, attention to weight control, exercise, and prevention of infections.

General prevention tips include:

Elbows and knees

  • Avoid leaning on elbows and knees
  • Kneel on a cushioned pad if necessary
  • Do not rub, scrub or manipulate the areas

Soles, corns and calluses

  • Wear low heal shoes so that your weight is distributed evenly on your sole
  • Avoid shoes that are tight around your toes or sides of the feet
  • Apply moleskin or other padding to areas of the feet that are being rubbed
  • Avoid going barefoot
  • Do not scrub or rub your soles

Types of Keratosis

Keratosis pilaris

Keratosis pilaris is a form of hyperkeratosis involving the back of the arms, the front of the thighs and inside the knees. With this form of hyperkeratosis small rough bumps appear around the follicles. Contrary to common belief, this condition is not caused by dirt. Although a cause has not been identified, keratosis pilaris is sometimes seen in association with ichthyosis vulgaris (see below) and less commonly with atopic dermatitis (eczema).

Ichthyosis

Ichthyosis is an inherited form of hyperkeratosis in which there is dry and scaly skin that resembles the scales of a fish. There are several different types of ichthyosis and the most common type is ichthyosis vulgaris.

Common forms of hyperkeratosis

Corns, calluses, eczema and warts are all also very common forms of hyperkeratosis.

Epidermolytic hyperkeratosis

Epidermolytic hyperkeratosis is a rare autosomal dominant genodermatosis that presents at birth with generalized erythema, blisters and erosions. In the subsequent months after birth erythema and blistering improves but patients go on to develop hyperkeratotic scaling that is especially prominent along the joint flexures, neck, hands and feet. The disease is caused by mutations in either keratin 1 or keratin 10. Treatment options include urea or alpha-hydroxy acid containing creams as well as topical and systemic retinoids. Epidermolytic hyperkeratosis is also known as bullous congenital ichthyosiform erythroderma (of Brocq) and disorder of cornification type 3.

Contractures hyperkeratosis lethal

A rare fatal congenital syndrome where numerous abnormalities arise from reduced fetal movement due to excessively tight skin. More detailed information about the symptoms, causes, and treatments of Contractures hyperkeratosis lethal is available below.

Nasodigital Hyperkeratosis

Nasodigital hyperkeratosis is characterized by hard, dry, and often cracked tissue on the nose or footpads. The appearance of the growths varies from regular to irregular projections of firm, feathered, and cracked horny tissue. The affected surface is dry and subject to painful and uncomfortable fissures and cracks. In many cases, just the edges of the nose or footpads are affected. In some dogs, however, the entire nose or footpad area can be affected.

Seborrheic keratosis

Seborrheic keratosis is one of the most common types of noncancerous (benign) skin growths in older adults. In fact, most people develop at least one seborrheic keratosis at some point in their lives.

A seborrheic keratosis usually appears as a brown, black or pale growth on the face, chest, shoulders and back. The growth has a waxy, scaly, slightly elevated appearance. Occasionally, it appears singly, but multiple growths are more common. Typically, seborrheic keratoses don't become cancerous, but they can look like skin cancer.

Note: If there is any doubt, you should have these checked by your dermatologist.

Actinic keratoses

Actinic keratoses (AKs) are dry, scaly, rough-textured patches or lesions that form on the outermost layer of the skin after years of exposure to ultraviolet (UV) light, such as sunlight. These lesions typically range in color from skin-toned to reddish brown and in size from that of a pinhead to larger than a quarter. Occasionally, a lesion grows to resemble an animal horn and is called a “cutaneous horn.”

Lichen planus

Lichen planus is a common inflammatory disease of the skin and mouth. It affects about one to two percent of the general population. The name “lichen” refers to the lichen plant which grows on rocks or trees, and “planus” means flat.

What is Hyperkeratosis

Hyperkeratosis is a thickening of the outer layer of the skin, which contains a tough, protective protein called keratin. This thickening is often part of the skin's normal protection against rubbing, pressure and other forms of local irritation, and causes calluses and corns on hands and feet or whitish areas inside the mouth. Other forms of hyperkeratosis can occur as part of the skin's defense against chronic (long-lasting) inflammation, infection, the radiation of sunlight or irritating chemicals. Less often, hyperkeratosis develops on skin that has not been irritated. These types of hyperkeratosis may be part of an inherited condition, may begin soon after birth and can affect skin on large areas of the body.

There are many examples of hyperkeratosis, including:

  • Corns and calluses — When areas of skin are exposed to repeated friction or pressure, thick layers of dead skin cells form the hardened areas we call corns and calluses. Corns usually develop on irritated toes, and calluses form on the soles of the feet and the palms of the hands. For many people, corns and calluses are simply a cosmetic nuisance, but for others, they are a painful and troublesome medical problem.
  • Warts — Warts are small bumps on the skin that are caused by human papilloma virus (HPV) infection. Plantar warts grow on the soles of the feet. HPV usually is spread by direct contact, typically by touching or shaking hands with someone who already has a wart or by coming in contact with a contaminated surface, especially by walking barefoot on a gym floor or a pool deck or by wearing someone else's shoes.
  • Chronic eczema — Eczema, also called dermatitis, is an inflammation of the skin that can be triggered by allergies, irritating chemicals and other factors. Eczema causes itching, redness and tiny blisters. When the inflammation is difficult to control, chronic eczema can lead to hyperkeratosis, dry skin, scaling, changes in skin color and localized hair loss.
  • Lichen planus — This condition may appear as a lacy white patch on the inside of the mouth or as an itchy, violet, scaly patch elsewhere on the skin. Although the cause of lichen planus is unknown, researchers suspect that it may be related to an abnormal reaction of the immune system.
  • Actinic keratoses — These are flat, red, rough sandpaperlike spots or patches of skin are caused by excessive exposure to the ultraviolet radiation of sunlight. They can be as tiny as a few millimeters. They occur on sun-exposed areas of skin, and they have the potential to develop into squamous cell carcinoma.
  • Seborrheic keratoses — These are small, noncancerous skin growths. They can be tan, brown or black and are found on the face, trunk, arms or legs. Seborrheic hyperkeratoses are very common, and most people develop between 1 and 20 during their lifetime. Their cause is a mystery.
  • Inherited conditions — Several inherited conditions cause hyperkeratosis. Lamellar ichthyosis, X-linked ichthyosis and ichthyosis vulgaris cause a widespread, thick, platelike scaling of the skin. Symptoms begin either shortly after birth or during early childhood.

Symptoms

Many forms of hyperkeratosis are painless. However, corns, calluses and plantar warts can cause a great deal of discomfort.

Diagnosis

Depending on your specific pattern of skin symptoms, your doctor will ask whether you have a family history of skin problems, and whether you have a personal history of allergies, frequent sun exposure, use of dentures or orthodontic dental appliances, unconscious chewing on your cheek or tongue or use of smokeless tobacco.

Sometimes, your doctor can diagnose the cause of your hyperkeratosis by reviewing your history and symptoms and by examining your skin. This often is the case with corns, calluses, warts and chronic eczema. If you have chronic eczema that could be allergy-related, the doctor may suggest that you have allergy testing.

In some cases, a biopsy may be taken to confirm the diagnosis. In a biopsy, a small piece of tissue is removed to be examined in a laboratory. If your doctor suspects that you have actinic keratoses, you may need to have a skin biopsy to confirm the diagnosis and rule out skin cancer.

If your child develops hyperkeratosis in many areas of his or her body, your doctor may review your family history and skin symptoms to determine if your child has an inherited disorder.

Expected Duration

How long a particular form of hyperkeratosis lasts depends on its cause. For example, corns and calluses usually will last as long as a person continues to wear poorly fitting shoes. Warts may disappear on their own, although this may take several months.

Once they develop, actinic keratoses or seborrheic keratoses are long-term conditions that do not disappear without treatment. Inherited forms of hyperkeratosis are lifelong conditions.

Prevention

Some forms of hyperkeratosis are very easy to prevent:

  • Corns and calluses — Wear comfortable shoes.
  • Plantar warts — Avoid going barefoot in gyms, locker rooms or pool areas.
  • Chronic eczema — Avoid potential triggers, such as extreme temperatures, dry air, harsh soaps, bubble baths or irritating chemicals to help to limit or prevent eczema symptoms. You also can try using blankets and wearing clothing made of cotton, rather than more irritating fabrics such as wool, silk and rough synthetics. Avoiding or removing triggers for your allergies also may help. When you have mild eczema, make sure you get and follow treatment advice to avoid developing chronic (long-lasting) eczema.
  • Actinic keratoses — Limit your sun exposure to early morning or late afternoon hours. Wear protective clothing and a hat when you go outdoors, and always apply a sunscreen with a sun protection factor (SPF) greater than 15.

Treatment

The treatment of hyperkeratosis depends on the type and possible cause:

Corns and calluses

Using moleskin or padding next to the affected area can help to relieve pain. Avoid further irritation that stimulates growth of the corn or callus. Never try to shave away or cut a corn or callus by yourself. Consult with your health care professional or a podiatrist.

Warts

Your health care professional or dermatologist can remove warts by freezing them with liquid nitrogen (cryosurgery), vaporizing them with a laser or trimming them away surgically. If the treatment does not reach the layer of skin infected with the virus, the wart can come back in the same place. Repeat treatments may be necessary. Although warts can be treated at home with nonprescription remedies, self-treatment may take longer than treatments in a medical setting. Self-treatment may be more effective after you have been treated by a health care professional, especially if a wart appears to be large or deep. If you have diabetes or poor circulation, you should always be treated by a health care professional to avoid injury and infection.

Chronic eczema

Your doctor usually will treat eczema by prescribing a corticosteroid ointment or cream for you to rub into the affected area. Moisturizing the skin is also very important.

Lichen planus

Like chronic eczema, lichen planus usually is treated with corticosteroid ointment or creams. Actinic keratoses — Your doctor may use cryosurgery to remove a single actinic keratosis. Multiple keratoses can be treated with skin peels, laser therapy or dermabrasion.

Seborrheic keratoses

A seborrheic keratosis can be removed with cryosurgery or with a scalpel.

Inherited conditions

There is no cure for these conditions. To treat large areas of scaly skin, your doctor may suggest bathing with bath oil or rubbing special emollients into the skin.

When To Call a Professional

Make an appointment to see a health care professional or podiatrist if you have painful corns or calluses or if you develop a painful thickening on your foot that looks like a plantar wart. People with diabetes should have their feet examined regularly by a podiatrist to avoid skin infections from corns, calluses or warts.

All adults should examine their skin regularly after age 20, especially if they have a history of working or playing for long hours in the sun. If you are not sure how to examine your skin yourself, ask your doctor for information about the proper technique. If you think you have an area of hyperkeratosis or eczema, schedule an appointment to see a health care professional. Whenever you notice that a skin growth or mole has changed color, size or shape, you should call your doctor for a more urgent appointment. Any new mole or other growth on the skin, should be checked for signs of cancer. If you have actinic keratoses, you should also call your doctor for treatment.

Prognosis

Most forms of hyperkeratosis are local skin problems that have a good prognosis. Actinic keratoses can develop into squamous cell skin cancer.

Source: Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved.

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External Links

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Cytologic, colposcopic and histopathologic correlations of hyperkeratosis in reproductive women.

Nov 2011

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Lymphedema People Links

Lymphedema People Resources

hyperkeratosis.txt · Last modified: 2012/10/16 14:40 (external edit)