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

• PPK (Palmoplantar Keratoderma)

What is Palmoplantar Keratoderma? (Definition/Background Information)

• Palmoplantar Keratoderma (PPK) is a benign skin condition, wherein there is thickening of skin (keratoderma) of the palms and/or soles. The skin condition is considered to be a pattern of skin findings and not a condition/disorder in itself
• The abnormal skin thickening can be focal (localized keratoderma), widespread (diffused keratoderma), or punctate-type (with the appearance of tiny bumps). Even though the palms and soles are mostly involved; in some cases, it may involve the top of the hands and feet too
• Palmoplantar Keratoderma may be acquired - meaning that it may occur due to various reasons either in childhood or adulthood, or it may be hereditary or congenital in nature (i.e., present at birth)
• There are a host of factors that can cause Palmoplantar Keratoderma, some of which include:
  • Acquired Palmoplantar Keratoderma that may be caused by infections, medications and drugs, or various skin disorders
  • Congenital Palmoplantar Keratoderma, which is caused by genetic abnormalities that may be inherited in an autosomal dominant or recessive manner
• A diagnosis of Palmoplantar Keratoderma can be made by clinical exam, skin exam, and various other diagnostic tools including dermoscopy and wood’s lamp examination. However, the diagnosis is often secondary to the underlying cause
• The treatment of Palmoplantar Keratoderma is based on the underlying cause of the condition. Nevertheless, the treatment of thickened skin may include the use of moisturizers, topical creams, and skin softeners
• The prognosis of Palmoplantar Keratoderma depends upon the type of keratoderma (whether acquired or congenital), the severity of the symptoms, the response to treatment, and most importantly upon the severity of the underlying condition

Who gets Palmoplantar Keratoderma? (Age and Sex Distribution)

• Palmoplantar Keratoderma may be observed in a wide age range of individuals including in infants and children
• The condition affects both males and females
• It is seen worldwide and all racial and ethnic groups may be affected

What are the Risk Factors for Palmoplantar Keratoderma? (Predisposing Factors)

• The acquired forms of Palmoplantar Keratoderma occur secondary to infections, medication use, chronic inflammatory conditions, circulatory disorders, and many other factors
• The risk factor for hereditary or congenital forms of Palmoplantar Keratoderma includes a positive family history of the condition

Nevertheless, the specific risk factors are contingent upon the underlying cause of the condition.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 Palmoplantar Keratoderma? (Etiology)

Palmoplantar Keratoderma may be acquired or hereditary in origin. The congenital (hereditary) form may be caused by genetic abnormalities which are passed down (through families) in an autosomal dominant or autosomal recessive pattern.

The acquired form of Palmoplantar Keratoderma may be caused by several diseases, conditions, or medications that are listed below:

• Infections including scabies, viral warts, fungal infections caused by Tinea sp., human papillomavirus (HPV), Reiter syndrome, AIDS, and syphilis
• Inflammatory skin conditions including systemic lupus erythematosus (SLE), psoriasis, pityriasis rubra, eczema, lichen planus, corns and calluses, etc.
• Drugs, medications, and toxins including cancer treatment drugs, dioxins, certain elements (such as iodine, lithium, and arsenic), polysaccharides, etc.
• Illnesses or conditions such as thyroid disease, certain cancers, malnutrition, lymphedema, keratoderma climacterum, etc.
• It may also occur secondary to certain genetic disorders such as ectodermal dysplasia, epidermolysis bullosa, and ichthyosis

What are the Signs and Symptoms of Palmoplantar Keratoderma?

The signs and symptoms associated with Palmoplantar Keratoderma may include:

• The presence of abnormally-thickened skin on the palms of the hands and soles of the feet
• The skin thickening may involve the entire palm and sole, or it may be localised to certain palmoplantar areas
• In some cases, abnormal small lumps may be present on the palms and soles
• Sometimes, the involvement of the hands and feet may be seen
• Other skin signs and symptoms may be present

The signs and symptoms of the underlying condition/infection may be noted.

How is Palmoplantar Keratoderma Diagnosed?

The diagnosis of Palmoplantar Keratoderma may involve:

• A complete evaluation of medical history along with a thorough examination of the skin lesions by a dermatologist
• The healthcare provider may also ask many questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical conditions, infections, etc.
• 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
• Genetic testing to identify the gene involved
• Skin biopsy: A skin 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
• Tests and procedures to establish the underlying cause of keratoderma will be undertaken

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 Palmoplantar Keratoderma?

Complications associated with Palmoplantar Keratoderma include complications associated with the cause of the condition.

How is Palmoplantar Keratoderma Treated?

The treatment of Palmoplantar Keratoderma is based upon the cause of the condition. However, the skin thickening may be addressed through skin softening treatment measures such as:

• Use of moisturizing creams and lotions; use of ointments containing vitamin D
• Use of topical and systemic retinoids
• Administration of keratolytics (medicine containing salicylic acid)

How can Palmoplantar Keratoderma be Prevented?

• The prevention of Palmoplantar Keratoderma depends upon the underlying cause of the skin condition. It may not be preventable in a majority of individuals
• In some cases, such as keratoderma caused by infections, certain illnesses, or when it is drug-induced, it may be possible to prevent PPK

In case of hereditary Palmoplantar Keratoderma, the following may be considered:

• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks before planning for a child
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders such as hereditary forms of Palmoplantar Keratoderma

What is the Prognosis of Palmoplantar Keratoderma? (Outcomes/Resolutions)

• The prognosis of Palmoplantar Keratoderma may depend on a set of several factors including:
  • Nature of underlying disorder and the severity of the signs and symptoms
  • Response to therapy of the underlying cause of keratoderma
• Even though the skin condition (keratoderma) is benign, the overall prognosis is based on the underlying condition and can be established only on a case-by-case basis
• Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Palmoplantar Keratoderma:

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.