8. PPK
must perform complete dermatological
examination including skin (atrophy,
knuckle pads, blisters, pseudoainhum) nails,
hair, and mucosa.
also impaired hearing cardiomyopathy
(in patients with woolly hair), starfish
keratoses
9. PPK
TRANSGREDIENS = hyperkeratosis
that crosses palm/sole edge
contiguously or as callosities on
pressure points on the fingers or
knuckles, or elsewhere
NON-TRANSGRADIENT =
hyperkeratosis involves only the palms
and soles
14. Acquired keratoderma
more common & occurs as a result
of a change in the health or the
environment of the affected person or
associated with skin disorders
18. Palmoplantar keratodermas
3.Punctate type: multiple small,
hyperkeratotic papules, spicules, or
nodules on the palms and soles may
involve the entire palmoplantar
surface or may be restricted to certain
locations
19. Palmoplantar keratodermas
The genetic basis of many keratodermas
particularly involves mutations in genes
encoding
Keratins
Connexins
desmosomal components
32. Pachyonychia congenita. A Thickening of
palmar skin & hypertrophic nail dystrophy with
wedgeshaped subungual hyperkeratosis.
B Painful focal plantar keratoderma
w/associated erythema& blistering
35. Focal type
1. Focal PPK areata type or striate type
(Brunauer-Fohs-Siemens syndrome)
2. Focal palmoplantar and gingival keratosis
(characterized clinically by focal PPK with
leukoplakic appearance on the labial surface
of the attached gingival lesion, and
histologically by focal epidermolytic PPK)
3. Focal keratoderma with oral leukokeratosis
4. Pachyonychia congenita
5. Focal PPK associated w/esophageal carcinoma
36. Punctate PPK Keratotic papules, some coalescing
to form plaques, on the palm (A) and sole (B).
48. Acquired PPK
NOT inherited as a primary genetic
condition. They may occur as part of a
generalised skin condition (some of
which may be inherited) or as a result of
another illness
50. CAUSES OF ACQUIRED KERATODERMA
I. INFLAMMATORY SKIN CONDITIONS
II. INFECTIONS
III. CIRCULATORY PROBLEMS
IV. 2ry TO INHERITED CONDITIONS THAT
MAY NOT USUALLY RESULT IN PPK
V. DRUGS AND TOXINS
VI. INTERNAL DISORDERS
VII. MISCELLANEOUS
60. Treatment
Treatment of all types of hereditary
and nonhereditary keratodermas can be
difficult.
Most treatment options only
result in short-term improvement
and are compounded frequently by side
effects
62. General Measures
Evaluation of family members in
hereditary case and genetic
counseling
In acquired cases, identify and
address possible underlying causes
Regular foot care, careful selection of
footwear, and treatment of fungal
infections are important
63. Topical
1. Keratolytics e.g. 5 – 10% salicylic acid,
10% lactic acid, or 10% urea in a neutral base
OR 6% salicylic acid in 70% propylene glycol
2.Emollients
3.Benzoic acid compounds
4.Topical retinoids tretinoin
5.Calcipotriol
6.Topical steroids in conditions where
there is an inflammatory component
64. Systemic
Retinoids effective, especially in some
hereditary PPKs such as Mal de Meleda,
Papillon-Lefevre syndrome, and
erythrokeratodermia variabilis but require
long-term treatment
65. Surgery
1. Dermabrasion
2. CO2 laser
3. Surgical excision: For severe,
difficult to treat keratoderma. Total
excision of hyperkeratotic skin followed
by grafts has been successful in a
number of cases