Transcript Keratosis pilaris

Elloisa Grace Ganaden MD
Subtopics
 Keratosis
Pilaris
 Callosities
 Calus
 Knuckle Pads
 Keratoma of palms and soles
Dyskeratosis

abnormal keratinization occurring
prematurely within individual cells or
groups of cells below the stratum
corneum.
Keratosis pilaris
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(KP, also follicular keratosis, lichen pilaris or
chicken skin)
is a common, autosomal dominant, genetic follicular
condition
extremely common benign condition manifested as
small, rough, slightly red, folliculocentric keratotic
papules/ bumps on the skin.
It most often appears on the back and outer sides of
the arm (though the forearm can also be affected),
and can also occur on the thighs, hands, and tops of
legs, sides, buttocks, or any body part except
glabrous skin (like the palms or soles of feet).
Pathophysiology

Genetically based disorder of
hyperkeratinization of the skin.
 Excess formation of keratin is cause
abrasive goose-bumps texture of the
skin.
 condition most often appears as a
proliferation of tiny hard bumps that are
seldom sore or itchy.
Clinical presentation:
HX: px report a rough texture (gooseflesh
apperance)
PE: skin of the outer-upper arms and
thighs is frequently affected.
10-100 very small, slighlty red rough
bumps scattered in area.
palpation reveal a fine, sandpaper like
texture.
DDX
Acne vulgaris
 Atopic dermatitis
 Folliculitis
 milia

Types of KP
>keratosis pilaris rubra - red, inflamed
bumps which can be on arms, head,
legs
>keratosis pilaris alba - rough, bumpy skin
with no irritation.
>keratosis pilaris rubra faceii - reddish
rash on the cheeks.
Treatment
moisturizing or keratolytic treatments
including: urea, lactic acid, salicylic acid,
or topical retinoids.
Callus (Callosity)
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is a toughened area of skin which has
become relatively thick and hard in
response to repeated friction, pressure,
or other irritation.
repeated contact is required, most often
found on feet.
generally not harmful, but may
sometimes lead to other problems, such
as skin ulceration or infection.
Corn(clavus,clavi)
Heloma
>specially-shaped callus of dead skin that
usually occurs on thin or glabrous (hairless
and smooth) skin surfaces, especially on
the dorsal surface of toes or fingers.
 They can sometimes occur on the thicker
palmar or plantar skin surfaces.
 Corns form when the pressure point
against the skin traces an elliptical or semielliptical path during the rubbing motion,
the center of which is at the point of
pressure, gradually widening.
pathophysiology

The bony prominences of the
metacarpophalangeal and
metatarsophalangeal joints often are
shaped in such a way to induce
overlying skin friction.(perpetuate
hyperkeratosis)
Hard corns(heloma darum)- occur on dry,
flat surfaces of skin.
Soft corns (heloma molle)- frequently
found between adjacent toes, stay
moist, keeping the surrounding skin soft.
Clinical presentation
HX: faulty mechanics; inappropriate
distribution of pressure and repetitive
motion injury
PE: lesion look like hyperkeratotic or thick
skin, maceration and secondary fungal
or bacterial infection are comon
Treatment
Calluses and corns may go away by
themselves eventually, once the irritation
is consistently avoided.
 They may also be dissolved with
keratolytic agents containing salicylic
acid, sanded down with a pumice stone
or filed down with a callus shaver.
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KNUCKLE PADS
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benign, asymptomatic, wellcircumscribed, freely movable, skincolored, wartlike, solitary or multiple
nodules and plaques up to 40 mm in
diameter located in the skin overlying
the dorsal aspects of the hands and
feet.
Pathophysiology
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Idiopathic, genetic, acquired as a
response to repetitive trauma.
Clinical presentation
Hx: asx, firm skin-colored papules
appear sequentially in multiple sites
overlying MCP and PIP joints in hands.
 PE: well circumscribed firm dermal
papules, nodules or plaque approx 0.53cm in size located extensor aspect of
PIP or MCP joints.
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DDX
Erythema elevatum diutinum
 Granuloma annulare
 xanthomas
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treatment
Eliminating the source of mechanical or
repetitive trauma may improve the
lesions.
 IL of corticosteroids
 Keratolytics
 Radiation therapy and application of
solid CO2
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Palmoplantar Keratodermas
Autosomal recessive and dominant,
heterogeneous group of disorders
characterized by abnormal thickening of
the palms and sole.
 Divided:
-acquired
-inherited
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Inherited:
3 distinct clinical pattern of epidermal
involvement.
3 distinct clinical patterns:
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1.diffuse PPK- uniform involvement of the
palmoplantar surface.
- this pattern is usually evident within the first few
months of life.
2. focal PPK - consists of localized areas of
hyperkeratosis located mainly on pressure points
and sites of recurrent friction.
3. punctate keratoderma - features multiple small,
hyperkeratotic papules, spicules, or nodules on the
palms and soles.
-this tiny keratoses may involve the entire
palmoplantar surface or may be restricted to certain
locations (eg, palmar creases).
Treatment and management
The most common therapeutic options only
result in short-term improvement and are
frequently compounded by unacceptable
adverse effects. Treatment tends to be
symptomatic and may vary from simple
measures
- saltwater soaks , topical keratolytics,
systemic retinoids, or reconstructive
surgery with total excision of the
hyperkeratotic skin followed by grafting.
Mainstay treatment
Topical keratolytics (eg, salicylic acid 5%,
lactic acid 10%, urea 10-40%) are useful in
patients with limited keratoderma.
 Topical retinoids (eg, tretinoin) are
effective, but treatment is often limited by
skin irritation.
 Consider potent topical steroids with or
without keratolytics in dermatoses with an
inflammatory component.
 Oral retinoids are effective
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Mainstay treatment:
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Psoralens and ultraviolet A (PUVA) or re-PUVA
(a combination of oral retinoids and PUVA)
may be indicated in persons with PPK
secondary to psoriasis or eczema.
Patients with oculocutaneous tyrosinemia may
benefit from dietary restriction of phenylalanine
and tyrosine.
Careful selection of footwear and treatment of
fungal infections are important.
Dermabrasion may permit increased
penetration of topical agents, and carbon
dioxide laser treatment may be beneficial in
persons with limited keratodermas.
Mainstay treatment:
For severe and refractory keratoderma,
consider surgery. Total excision of
hyperkeratotic skin followed by grafting
has been successful in a number of
cases.
 Paraneoplastic keratodermas are
generally refractory to local treatment
and may only respond to removal of the
underlying neoplasm.
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