Literally peels off the excessive skin!!! The person shown here is suffering from a focal palmoplantar keratoderma on his foot!
Palmoplantar keratodermas are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles.
This can cause difficulty with walking, because of pain in the feet. The thick skin and sweating of the feet makes them particularly susceptible to odor, and to fungal infection. The thick skin on the palms may reduce sensitivity in the finger tips, impairing manual dexterity.
All these problems, together with the unusual appearance can be stressful and lead to psychological difficulties.
They are classified as either hereditary or acquired and are distinguished from each other on the basis of mode of inheritance, presence of transgrediens (defined as contiguous extension of hyperkeratosis beyond the palmar or plantar skin), co-morbidities, and extent of epidermal involvement, namely diffuse, focal, and punctate.
Diffuse palmoplantar keratoderma is characterized by an even, thick, symmetric hyperkeratosis over the whole of the palm and sole, usually evident at birth or in the first few months of life.
Focal palmoplantar keratoderma is a type in which large, compact masses of keratin develop at sites of recurrent friction, principally on the feet, although also on the palms and other sites, a pattern of calluses that may be discoid or linear.
In the Punctate type, many tiny “raindrop” keratoses involve the palmoplantar surface, skin lesions which may involve the whole of the palmoplantar surface, or may be more restricted in their distribution
In rare forms, organs other than the skin may also be affected.
The inherited form is caused by genetic mutations that result in abnormalities of keratin, a skin protein. Depending on the genetic cause, inheritance can be autosomal dominant or recessive. Treatment is aimed at softening the thickened skin to make it less noticeable and relieve discomfort.
Conservative treatment options include topical keratolytics, repeated physical debridement, topical retinoids, topical psoralen plus UVA, and topical corticosteroids.