Hyperkeratosis is an excessive thickening of the stratum corneum of the epidermis. The concept of hyperkeratosis comes from two Greek words hyper – a lot and keratosis – keratin formation. The cells of the stratum corneum begin to divide intensively, which, in combination with violations of the peeling of the epidermis, leads to thickening, which can be from several millimeters to several centimeters. There are follicular, lenticular and disseminated hyperkeratosis. At the heart of the disease is a violation of the process of peeling of the superficial epithelium of the skin, which can occur with excessive compression of the skin area, for example, tight clothing or shoes.
Causes of hyperkeratosis
Hyperkeratosis is not an independent disease. Thickening of the stratum corneum and disruption of the keratinization process are observed in ichthyosis, lichen, erythroderma and other diseases. Even in healthy people, hyperkeratosis manifests itself to one degree or another on the elbows, feet, and sometimes on the knees.
Exogenous causes of this disease, that is, causes arising from the outside are prolonged and excessive pressure on the skin of the feet, sometimes on the skin of the body due to tight or coarse clothing. Pressure, like any external aggression, provokes the body’s defense mechanisms, in this case, increased cell division. The natural process of cell peeling is disrupted: when surface cells are exfoliated, and newly formed cells come in their place. And, as a result, there is a thickening of the stratum corneum of the epidermis – hyperkeratosis.
Since most of the load falls on the feet, it is they who are susceptible to the formation of hyperkeratosis. Narrow, tight and vice versa shoes of a larger size than necessary cause thickening of the skin of the foot. Overweight, especially with high growth, also multiply the load on the foot. In people with foot pathologies, for example, with flat feet, due to violations of the cushioning properties of the spine, hyperkeratosis of the feet is much more common. Acquired foot pathologies, as well as lameness, lead to a redistribution of loads on the foot, resulting in areas of increased pressure and localized hyperkeratosis.
The endogenous causes of hyperkeratosis include various systemic diseases that occur chronically. The most common endogenous cause of hyperkeratosis is diabetes mellitus, since as a result of metabolic disorders, a whole complex of causes leading to impaired sensitivity develops. Tactile and pain sensitivity is dulled, metabolic disorders develop, skin nutrition is disrupted and its dryness develops. These factors are the main ones in the development of hyperkeratosis of the feet in diabetes mellitus.
More rare causes of hyperkeratosis are hereditary disorders in the formation of keratin, keratodermia, skin ichthyosis, psoriasis and other diseases in which the state of the epidermis changes.
Follicular hyperkeratosis is one of the clinical symptoms of skin diseases, although hyperkeratosis of follicles is also observed as an independent symptom. As a result of excessive keratinization and disruption of the detachment of the upper layers of the epidermis, the follicle duct is blocked by skin scales. In people whose relatives suffered from follicular hyperkeratosis, the incidence rate is higher. Vitamin A and C deficiency, as well as violations of personal hygiene are also risk factors. When exposed to cold, hard water and other physical factors on the skin, follicular hyperkeratosis can also develop in people with unchanged skin functions. After the restoration of the previous mode of life, the symptoms of hyperkeratosis disappear.
Clinically, follicular hyperkeratosis manifests itself in the form of small red pimples-bumps in the place of follicles, the skin becomes like a goose. Affected areas of the body prone to dry skin. This is the area of the elbow and knee joints, buttocks and the outer surface of the thighs. With prolonged exposure to adverse factors, hyperkeratosis of the follicles becomes widespread, the skin of the hands and lower extremities is affected. A red, sometimes inflamed, rim forms around the nodules. If, along with the symptoms of hyperkeratosis, there is a constant mechanical impact, for example, rough clothing, then the skin becomes rough and resembles toad skin. Nodules of follicular hyperkeratosis become infected with self-extrusion or with involuntary traumatization, which can lead to secondary pyoderma.
Follicular hyperkeratosis is not a life-threatening condition, but meanwhile requires treatment, since cosmetic defects can cause psychological trauma. The diagnosis is made on the basis of clinical manifestations. To date, there are no drugs that could solve the problem of patients with follicular hyperkeratosis. In the event that this symptom is one of the manifestations of diseases of internal organs, then their treatment or correction can completely eliminate the manifestations of follicular hyperkeratosis. Therefore, patients with follicular hyperkeratosis, which has a long course, need to be examined by both a dermatologist and an endocrinologist and a therapist.
Treatment of follicular hyperkeratosis is aimed at correcting the work of internal organs and the use of emollient ointments and local preparations that contain lactic and fruit acids that have a peeling effect. The use of mechanical scrubs and pumice stone in follicular hyperkeratosis is contraindicated, since traumatization can lead to infection or to the progression of symptoms.
Vitamins A and C, taken both internally and externally in the form of ointments, are able to correct the process of peeling of the epithelium and the process of formation of new cells. Cosmetologists and dermatocosmetologists are engaged in the treatment of follicular hyperkeratosis, but with age, the symptoms of follicular hyperkeratosis usually decrease or disappear completely. This is due to a decrease in sebum formation and a decrease in the rate of division of epidermal cells.
Lenticular and disseminated hyperkeratosis
The causes of these hyperkeratoses have not been studied, the pathogenesis is based on a violation of the processes of keratin formation of unknown origin associated with changes in the human genome. These types of hyperkeratoses are diagnosed mainly in older men, but often the symptoms begin to manifest in youth.
The disease proceeds chronically, without tendencies to regression, after insolation, exacerbations are noted. In the places of the follicles, horny papules appear from 1 to 5 mm in size, reddish-brown or yellow-orange in color. The back surface of the feet, lower legs and thighs is affected, the follicles of the arms, trunk and auricles are less often affected. In isolated cases, lenticular hyperkeratosis is diagnosed on the oral mucosa. When the corneal plug is removed, a slightly moist depression with spot bleeding in the center is exposed. Papules are scattered in nature, are not prone to fusion, do not cause painful sensations. A small proportion of patients report slight itching in areas affected by lenticular hyperkeratosis.
With disseminated hyperkeratosis, polymorphic elements appear on the skin, resembling short and thick hair, which are located in isolation without a tendency to merge on the skin of the trunk and limbs. Sometimes there are clusters in groups in the form of a brush of 3-6 affected follicles. Histological examination is used to differentiate disseminated and lenticular hyperkeratosis from papillomas, ichthyosis and warts.
Treatment consists in the use of ointments containing glucocorticosteroids and aromatic retinoids. Hyperkeratoses do not pose a danger to life, but they are a cosmetic defect. Chemical peels performed by dermatocosmetologists and procedures aimed at moisturizing and softening the skin with regular use can solve the problem. It should be remembered that mechanical action, the use of scrubs and pumice are extremely undesirable, as they lead to exacerbations and to the attachment of secondary pyoderma.
Plantar hyperkeratosis is most often a cosmetic defect, although the condition of the skin of the foot often indicates the state of the body as a whole. Since hyperkeratosis of the foot can reach several centimeters, dry skin due to body pressure is prone to the formation of painful and bleeding cracks, which leads to pain when walking and infection.
About 40% of women and 20% of men after the age of twenty note clinical manifestations of plantar hyperkeratosis, which, in addition to thickening of the skin, is clinically manifested by cracks, pain and burning when walking and a feeling of stiffness of the feet.
The main causes of hyperkeratosis of the feet are tight and uncomfortable shoes, irregular foot care, hereditary and acquired pathologies of the foot, overweight and diseases of the internal organs in which the formation of keratin is disrupted.
The coarsening and thickening of the skin begins gradually. With age, the skin “gives up” and symptoms of hyperkeratosis appear. But, however, proper and adequate foot skin care is able to completely solve this problem, at least clinically.
If plantar hyperkeratosis and the appearance of corns is observed on the entire surface of the heels, then the most likely cause is a fungal foot disease or endocrine disorders. Hyperkeratosis along the outer edge of the heel indicates the heel turning inward during walking. And, the more distinct the clinical manifestations, the more the motor stereotype is changed; the main cause is congenital or acquired clubfoot and injuries of the motor apparatus.
Hyperkeratosis of the inner edge of the foot appears with an incorrect position of the heel, weak ligaments of the ankle joint and lower leg muscles. Overweight, flat feet and high loads on the ankle joint, as a rule, are the main causes of plantar hyperkeratosis of this zone. In patients with similar problems, the inner part of the heel quickly wears out, and the shoes become unusable. With hyperkeratosis of the rear edge of the heel, it is enough to change shoes to a more comfortable one so that the condition of the skin of the foot is normalized, since shoes, when worn with the sole point of support being the heel or the base of the toes, are unsuitable for permanent wear. Longitudinal flat feet lead to coarsening of the middle part of the foot.
Treatment of plantar hyperkeratosis is carried out in the office of a podiatrist. This is symptomatic therapy, and therefore it is necessary to eliminate the main cause of hyperkeratosis of the foot. If this is due only to uncomfortable shoes, then it is necessary to choose shoes for daily wear in which the load on the foot is evenly distributed. If there are orthopedic diseases, then their correction should be handled by an orthopedic doctor. It is also necessary to treat or correct endocrine disorders, antifungal therapy, if the cause of hyperkeratosis is mycotic lesions of the feet.
When cracks appear, applications with syntomycin ointment and lubrication of the affected areas with retinol solution are used. After healing of cracks, it is necessary to remove excess skin masses. Treatment at home is somewhat lengthy and requires patience. Salt foot baths with cool water, pumice stone and mechanical grinding are used. Moisturizing the skin of the feet and the use of keratolytic ointments are also included in the treatment regimen.
When eliminating the symptoms of hyperkeratosis in the conditions of the podologist’s office, more aggressive softeners are used, which allows you to completely get rid of the manifestations of plantar hyperkeratosis in a few procedures. However, without proper care and preventive procedures, hyperkeratosis of the feet can return again. It should be remembered that with age, the coarsening of the skin of the feet manifests itself more clearly, and the prevention of hyperkeratosis of the feet is proper foot care and wearing comfortable shoes. Correction of overweight and prevention of fungal diseases also help to preserve the beauty and health of the legs.