|Year : 1997 | Volume
| Issue : 2 | Page : 85-88
Hyperkeratosis of palms and soles : clinical study
A Chopra, Maninder, SS Gill
Source of Support: None, Conflict of Interest: None
Typical lesions of hyperkeratosis of palms and soles do not create any problem but when slight variation is there it becomes difficult to diagnose and that changes the line of treatment. For that we have studied 300 fresh cases of hyperkeratosis of palms and soles which included 110 cases of hyperkeratotic eczema. 42 cases of hyperkeratotic tinea, 64 cases of psoriasis of palms and soles and 84 cases of pustulosis palmaris et plantaris (PPP). To reach the final diagnosis alongwith the detailed history, general physical examination and routine investigations, help was taken of special investigations like pus for culture and sensitivity, KOH smear examination of skin scrapings and nail cutting and culture on Sabouraud's dextrose agar medium.
Keywords: Hyperkeratosis, Palms & soles, Fissured, Erythematous, Pustules
|How to cite this article:|
Chopra A, Maninder, Gill S S. Hyperkeratosis of palms and soles : clinical study. Indian J Dermatol Venereol Leprol 1997;63:85-8
|How to cite this URL:|
Chopra A, Maninder, Gill S S. Hyperkeratosis of palms and soles : clinical study. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2020 Aug 6];63:85-8. Available from: http://www.ijdvl.com/text.asp?1997/63/2/85/4524
| Introduction|| |
Acquired cases of hyperkeratosis of palms and soles encountred in clinical practice are hyperkeratotic eczema, hyperkeratotic tinea, psoriasis of palms and soles and pustulosis palmaris et plantaris (PPP). Hyperkeratotic eczema is charcterised by scaly fissured hyperkeratotic patches proximally or in the middle of palms, volar surfaces of fingers and plantar surface of feet on weight bearing areas with varying itching, absence of vesicles or pustules and no nail nivolvement. Tinea pedis caused by Trichophyton rubrum produces squamous hyperkeratotic variety of chronic lesions affecting the soles, heels and sides of foot covered by fine white scales and with extensive involvement of foot, is called 'moccassin foot'. On palms, the hyperkeratotic tinea affects the skin diffusely with accentuation of flexural creases. Marked itching and unilaterality are the characteristic features. Psoriasis of palms and soles present as erythematous sharply circumscribed typical scaly patches with silvery white scales and peripheral overhanging scale on palms, sides of fingers, finger tips and on the extensor surfaces of joints. PPP is a chronic eruption of yellowish sterile pustules on thenar, hypothenar eminences on hands and on feet, the instep, medial or lateral border, sides or back of heel.
| Materials and Methods|| |
The material for the present study was obtained from the outpatient department of Dermatology and Venereology, Rajendra Hospital and Medical College, Patiala(Punjab) from March 1994 to December 1995. 300 cases of hyperkeratosis of palms and soles were included in the present study, who had not taken any treatment before.
In every case a detailed clinical history was taken. Complete general physical and systemic examinations were done. Routine investigations included Hb estimation, total leucocyte count, differential leucocyte count, complete examination of urine and stools, SGOT, SGPT, blood urea, TSP, DSP and ESR.
Pus for culture and sensitivity was taken in case where pustules were present. Material was taken with a sterile swab taking all aseptic precautions and was sent to microbiology department for bacteriological analysis. Skin scraping for fungus was done in all cases where scaling was prominent and nail cuttings for fungus was done in all suspected cases. Skin scrapings were kept in 10% KOH for 5-10 minutes and nails for 24 hours and looked for spores and septate hyphae. Culture for fungus was done in all KOH negative cases on Sabouraud's dextrose agar medium.
| Results|| |
The results of the above study were compiled and out of 300 clinically diagnosed cases, 64 were of psoriasis of palms and soles, 84 of pustulosis palmaris et plantaris, 42 of tinea pedis and manuum and 110 were of hyperkeratotic eczema. A statistical analysis of the results of different group was made wherever necessary.
(i) Age incidence: Average age group for psoriasis of palms and soles was 27 years, in PPP 15.5 years, in hyperkeratotic tinea 14.2 years and in hyperkeratotic eczema 42.30 years.
(ii) Sex incidence: In psoriasis of palms and soles 36 (56.25%) were male and 28 (43.75%) were female, in PPP 33 (79.28%) were male and 51 (60.72%) were female, in hyperkeratotic tinea 29(69.04) were male and 13 (30.98%) were female and in hyperkeratotic eczema 67 (60.90%) were male and 43 (39.09%) were female. In all the above cases there was predominance of males over females except in PPP where more females were involved.
(iii) Duration of disease: In psoriasis of palms and soles 24 (37.5%) had duration of disease of <6 months-2.5 years, 17 (26.56%) had 1-1.5 years, 11 (17.1%) had 2-3.5 years and only in 3 (4.68%) it varied between 5-10 years. In PPP, 55.9% had duration between 0-6 months, in 16 (19%) it was between 1-1.5 years, in 11 (13.09%) it was between 2-2.5 years and in 8 (9.5%) between 3-5 years. In hyperkeratotic tinea 21 (50%) had duration of 6 months, in 11 (26.6%) between 7 months-2.5 years, in 4 (9.52%) between 3-5 years and in 1 case between 5-10 years. In hyperkeratotic eczema 24 (21.8%) had duration varying between 2-2.5 years, 48 (43.63%) between 3-5 years, 25 (22.72%) between 5-10 years and in 4 more than 10 years. In psoriasis of palms and soles the duration varried from 1-10 years, in PPP from <6 months-5 years, in hyperkeratotic tinea from 6 months-10 years, and in hyperkeratotic eczema from 3-10 years.
(iv) Familial occurrence of disease: The frequency of familial occurrence in psoriasis of palms and soles was found to be 7.81%, in PPP 1.19%, in hyperkeratotic tinea 4.76% and in hyperkeratotic eczema 1.81%.
(v) Seasonal variation of the disease: In psoriasis of palms and soles 12 (18.75%) had exacerbation in winters, 13 (15.47%) cases of PPP had exacerbation in winters, in hyperkeratotic tinea 13 (30.94%) had exacerbation in summers and in hyperkeratotic eczema in 77 (70%) there was exacerbation in winters.
(vi) History of itching: In psoriasis of palms and soles no patient complained of itching. In PPP, 28 (33.3%) complained of mild itching and 5 (5.95%) complained of moderate to severe itching. In tinea, 13 (30.95%) complained of mild itching, 14 (33.33%) complained of moderate itching and 11 (26.19%) complained of marked itching. In hyperkeratotic eczema 49 (44.54%) complained of mild itching and 1 (0.9%) complained of moderate itching.
(vii) Symmetry of disease: All cases of psoriasis of palms and soles and hyperkeratotic θczema had bilateral symmetry. In PPP, 78 (92.85%) had bilateral symmetry and 6 (7.14%) were unilateral. In tinea 9 (21.42%) had bilateral symmetrical lesions and 33 (78.57%) were unilateral.
(viii) Incidence of involvement of nails: In psoriasis of palms and soles 15 (23.43%) had involvement of nails, in pustulosis palmaris et plantaris 13 (15.47%), in tinea 27 (64.28%) and in hyperkeratotic eczema 7 (6.36%) had involvement of nails.
(ix) Investigations: Positivity of skin scrapings for fungus on KOH examinations was obtained in 16 (38.09%) cases out of 42. Positivity of nail cuttings for fungus was obtained in 20 (47.61%) cases out of 42 with clinical involvement in 27 cases. Culture was done in 22 KOH negative cases on Sabouraud's dextrose agar medium and positive culture of Trichophyton mentagrophytes was obtained in 1 case only.
| Disscussion|| |
Psoriasis of palms and soles is a disease of middle aged adults, PPP and hyperkeratotic tinea is a disease of young adults whereas hyperkeratotic eczema is a disease of middle aged to elderly people. Our study is in accordance with the study of Verma et al (1976) who also found that maximum number of patients of psoriasis of palms and soles were between 21-40 years. Hersle and Mobacken found the mean age for hyperkeratotic eczema as 46 years.
In psoriasis of palms and soles, hyperkeratotic tinea and hyperkeratotic eczema there is predominance of males with M:F ratio of 1.28:1, 2.23:1 and 1.55:1 respectively whereas in PPP, there is female predominance with F:M ratio of 1.54:1 Hellgran have also reported a incidence of 56.7% in men and 43.3% in women in psoriasis of palms and soles. Ashurst (1964) in a clinical study of 43 cases of PPP found females to be effected 8 times more frequently than males.
In most cases of psoriasis of palms and soles the duration varied from <6 months-2years, in PPP from <6 months-2 years, in hyperkeratotic tinea it was 1.5 years and in hyperkeratotic eczema it varied from 3-10 years.
Familial occurrence was significant only in psoriasis of palms and soles. Sharma et al (1964) found a family history of l3.3%.
In palmar and plantar psoriasis and PPP there was aggrevation of disease in winters whereas in tinea there was worsening in summer, spring and monsoon, while in hyperkeratotic eczema there was improvement in summers. Awachat et al (1960) also reported that prosiasis attacks are more frequent in winter.
Itching was concluded as an important symptom in tinea pedis and manuum. In PPP and in hyperkeratotic eczema few complained of itching. Banerjee et al found itching as the most common symptom in patients of tinea.
In psoriasis of palms and soles and hyperkeratotic eczema the symmetry is usually bilateral, in PPP it is bilateral but can be unilateral and tinea is usually unilateral. Awachat (1960) reported that psoriasis of palms and soles is bilateral in distribution.
There was significant involvement of nails in psoriasis of palms and soles, PPP, and hyperkeratotic tinea but in hyperkeratotic eczema nail involvement was insignificant. Sutton and Ayres (1935) have also described no nail involvement in hyperkeratotic eczema.
Our findings are not in accordance with the findings of following authors. Ashurst et al (1964) found average age group for the onset of PPP as 31-50 years. Hersle and Mobacken (1982) have also reported significant family history in hyperkeratotic eczema.
Keeping all these points in view the clinical differentiation becomes very easy and that leads to proper treatment at the early stage.
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