What are the other Names for this Condition? (Also known as/Synonyms)

• Hyperkeratotic Dermatitis of the Palms
• Hyperkeratotic Hand Eczema (HHE)
• Psoriasiform Palmar Eczema

What is Hyperkeratotic Palmar Dermatitis? (Definition/Background Information)

• Hyperkeratotic Palmar Dermatitis, also known as Hyperkeratotic Hand Eczema (HHE), is a skin condition of unknown cause that is defined by a localized thickening of the outer skin layers of the palms of one’s hands. The condition is mostly observed in middle-aged men
• The treatment of Hyperkeratotic Palmar Dermatitis may involve topical gels and creams, physical therapy, and systemic therapy through medications. However, it is reported that the response to topical treatments is poorer compared to other forms of hand eczema

Who gets Hyperkeratotic Palmar Dermatitis? (Age and Sex Distribution)

• Hyperkeratotic Palmar Dermatitis may be observed in both children and adults. However, a greater number of cases occur in middle age
• Both males and females are affected, but more men are affected than women
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization has been reported

What are the Risk Factors for Hyperkeratotic Palmar Dermatitis? (Predisposing Factors)

The risk factors for Hyperkeratotic Palmar Dermatitis may include the following:

• Manual work i.e., using one’s hands to perform tasks, may be a risk factor
• No irritants or allergens associated with hand dermatitis, which may provoke Hyperkeratotic Palmar Dermatitis, have been clearly identified
• No family history of the condition is also reported

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hyperkeratotic Palmar Dermatitis? (Etiology)

The cause of development of primary Hyperkeratotic Palmar Dermatitis is unknown. It is believed that the skin condition may develop due to certain internal (genetic and/or immune-based) and external (environmental) factors.

• No inherited gene mutations have been so far associated with Hyperkeratotic Palmar Dermatitis
• Even though the condition is described as a form of eczema, the predisposing factors that cause eczema are not associated with this form of hand eczema
• The condition is not associated with skin conditions, such as atopic eczema or palmar psoriasis, even though there may be some overlapping features

What are the Signs and Symptoms of Hyperkeratotic Palmar Dermatitis?

The signs and symptoms of Hyperkeratotic Palmar Dermatitis may include:

• Sharply demarcated skin lesions on the palms
• These thick skin lesions may be in the form of cracks or fissures
• The condition is associated with itching and pain (particularly if cracks are noted)
• Onset of the skin condition may begin with one palm, but soon may progress to involve both palms
• In many cases, even the fingers are involved; however, the nails are spared
• There are no blister formation or oozing of discharges from the lesions

In rare cases, the soles of the feet may be affected. However, no systemic signs and symptoms are seen.

How is Hyperkeratotic Palmar Dermatitis Diagnosed?

A diagnosis of Hyperkeratotic Palmar Dermatitis may involve the following tests and exams:

• A thorough medical history and physical examination
• Culture studies to detect any bacterial or fungal infection
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin patch testing, if necessary
• Skin biopsy (if required): A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A biopsy may be performed to rule out other skin conditions with similar signs and symptoms.

A differential diagnosis is important to exclude skin disorders that present similar signs and symptoms. These may include:

• Allergic contact dermatitis
• Atopic eczema
• Fungal infection
• Irritant contact dermatitis
• Lichen simplex chronicus
• Palmar psoriasis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hyperkeratotic Palmar Dermatitis?

The complications of Hyperkeratotic Palmar Dermatitis may include:

• Severe emotional stress due to cosmetic issues
• Unable to perform one’s normal activities
• Reduced quality of life
• Superimposed bacterial and fungal skin infections
• The condition may become chronic
• Treatment complications - the condition does not respond well to application of skin creams and lotions

How is Hyperkeratotic Palmar Dermatitis Treated?

The treatment of Hyperkeratotic Palmar Dermatitis may involve the following measures, based on the healthcare provider’s assessment:

• Use of topical applications (gels and creams), including moisturizers, coal tar, corticosteroids, and keratolytic agents
• Phototherapy and UV therapy
• Administration of medications including methotrexate and cyclosporin

Periodic follow up visits to the healthcare provider are important and recommended.

A few self-care tips and home remedies may include:

• Avoid scratching the affected area on the hand (keep fingernails trimmed)
• A cool bath may help soothe the skin
• Minimize frequent wet works, including frequent handwashing
• Use prescribed soaps and handwash liquids
• Use suitable hand gloves for performing any manual jobs; ensure proper cleanliness and hygienic maintenance of the gloves

How can Hyperkeratotic Palmar Dermatitis be Prevented?

Currently, there are no known methods available to prevent the occurrence of Hyperkeratotic Palmar Dermatitis.

What is the Prognosis of Hyperkeratotic Palmar Dermatitis? (Outcomes/Resolutions)

The prognosis of Hyperkeratotic Palmar Dermatitis depends on the severity of the condition. No spontaneous resolution of the condition is reported.

• The prognosis varies from one individual to another on a case-by-case basis
• In many individuals, the condition is persistent and chronic necessitating long-term treatment

Additional and Relevant Useful Information for Hyperkeratotic Palmar Dermatitis:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition

The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse