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  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    References

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CASE REPORT
Year : 2002  |  Volume : 68  |  Issue : 4  |  Page : 242

Palmoplantar keratoderma in myxedema


Department of Dermatology and Venereology, Govt. Medical College and Rajindra Hospital Patiala - 147 001, Punjab, India

Correspondence Address:
#97, New Lal Bagh, Patiala - 147 001, Punjab, India

   Abstract 

A 45-years-old woman came with diffuse yellowwaxy thickening, dryness and scaly skin of palms and soles and thickening of knuckles on dorsa of hands since 2 years. In addition, she had hoarseness of voice, weight gain, slow response, intolerance to cold, loss of pubic and axillary hair, generalised dryness and coarseness of skin, and mask like fades. Diagnosis of palmoplantar keratoderma and myxedema was confirmed by investigations.

How to cite this article:
Mittal R R, Jha A. Palmoplantar keratoderma in myxedema. Indian J Dermatol Venereol Leprol 2002;68:242


How to cite this URL:
Mittal R R, Jha A. Palmoplantar keratoderma in myxedema. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2019 Oct 16];68:242. Available from: http://www.ijdvl.com/text.asp?2002/68/4/242/12532



   Introduction Top

Palmoplantar keratoderma (PPK) is a multjetiological disorder which is subclassified into two main types that is hereditary- congenital and acquired.[1] Acquired PPK may be associated with neurodermatitis, psoriasis, lichen planus, tineasis, Reiter's syndrome, pityriasis rubra pilarjs, verrucae, fungal infections, keratoderma climactericum, contact dermatitis and syphilis.[2] PPK in association with myxedema was first reported 1952.[3] Myxedema associated with severe palmar keratodema was reported later in 1977[4] followed by another case report in 1986.[5] Increased propensity to overkeratinisation could be responsible for PPK. Striking improvement in long standing PPK with thyroid hormones, further supported that causal relationship was possible between PPK and myxedema.[5]

   Case Report Top

A 45-year-old woman came with the complaint of non pruritic diffuse thickening of plams and soles for the past 2 years. The patient gave history of weight gain, hoarseness of voice, stiffness of joints, difficulty in extension of hand, intolerance to cold and was in menopause for past 1 year. The patient was alert though her responses were slow. There was generalized coarseness, dryness of skin and loss of pubic and axillary hair. The palms and soles showed diffuse yellow, waxy, hyperkeratotic skin. The dorsa of the hands also showed thickening which was more prominent on the knuckles.
The endocrine function tests showed: serum T3-0.92ng/ml (normal: 0.8-1.8), T46.7mcg/dl (normal: 5-11.5) and TSH-4.2 ľu/ml (normal: 0.25-3.8), thus confirming the diagnosis of myxedema. Cholesterol level was 180 mg%. Skin biopsy was taken from the sole and showed the following: marked hyperkeratosis, hypergranulosis and acanthosis.
The patient was put on thyroid hormone (eltroxin 150mgOD) and topical, keratolytics and steroids, Steady improvement occurred in the form of disappearance of stiffness of fingers, decrease in thickness, dryness of skin and disappearance of scales, during 8 months therapy and followup.

   Discussion Top

The present case could be of PPK due to associated myxedema or a case of PPK climactericum. PPK climactericum was excluded as involvement was diffuse and histopathology showed no feature of spongiosis with exocytosis.[6] She had taken treatment from other sources but improvement this time was far better after topical therapy along with thyroid hormone. This also favoured the fact that PPK was due to myxedema. We do agree with the opinion of Hodak et al that although rare, myxedema could be a cause of PPK due to its propensity for overkeratinisation and addition of thyroid hormone therapy helps in treating PPK. 

   References Top

1.Itin PH, Lautenschlager S. Palmoplantar keratoderma and associated syndromes. Seminars in Dermatology 1995;14:152-161.  Back to cited text no. 1    
2.Zemtsov A, Veitschegger M. Keratodermas. Int J Dermatol 1993;32:493-498.  Back to cited text no. 2    
3.Shaw WM, Mason EH, Kalz EG. Hypothyroidism, liver damage and vitamin A deficiency as factors in hyperkeratosis. Arch Dermatol Syph 1952;66:197-203.  Back to cited text no. 3    
4.Tan OT, Sarkany I. Severe palmar keratoderma in myxedemo. Clin Exp Dermatol 1997;2:287-288.  Back to cited text no. 4    
5.Hodak E, David M, Feuerman EJ. Palmoplantar keratoderma in association with myxedema. Acta Derm Venereal (Stockh) 1986;66:354-357.  Back to cited text no. 5    
6.Deschamps P, Leroy D, Pedailles S, et al. Keratoderma climoctericum (Haxthauser s disease): Clinical signs, laboratory findings and etretinate treatment in 10 patients. Dermatologica 1986;172:258-262.  Back to cited text no. 6    

 

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