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Suggest Treatment For Planter Keratoderma
Question: Hello Doctor,
My husband, XXXXXXX has developed some sort of allergy/infection under both his feet. I’ve attached the pictures of those.
The problem has been there since a year. A local dermatologist, we showed to, diagnosed it as Palmoplantar Pustulosis and advised the following medicines:
nuforce-150mg tabs -qty 8 daily once
primosa 500mg cap -qty-48 daily once
After tablets' course finishes , he advised to apply
DIPSALIC-F 20gm OINT daily once at night
SOVARATE-C 20gm OINT daily once at morning
Fucibet application helps,but as soon as stopped, the infection increases.
During the previous visit, we have already done the below test and found it is normal:
[1]TSH
[2]Blood Sugar
[3]Liver function test
The infection seems to have aggravated over time. He has developed cracks and they occassionally also pain a lot. Unlike before, its become itchy too in the last 2 weeks.
Please advise.
Thanks,
XXXXXX
My husband, XXXXXXX has developed some sort of allergy/infection under both his feet. I’ve attached the pictures of those.
The problem has been there since a year. A local dermatologist, we showed to, diagnosed it as Palmoplantar Pustulosis and advised the following medicines:
nuforce-150mg tabs -qty 8 daily once
primosa 500mg cap -qty-48 daily once
After tablets' course finishes , he advised to apply
DIPSALIC-F 20gm OINT daily once at night
SOVARATE-C 20gm OINT daily once at morning
Fucibet application helps,but as soon as stopped, the infection increases.
During the previous visit, we have already done the below test and found it is normal:
[1]TSH
[2]Blood Sugar
[3]Liver function test
The infection seems to have aggravated over time. He has developed cracks and they occassionally also pain a lot. Unlike before, its become itchy too in the last 2 weeks.
Please advise.
Thanks,
XXXXXX
Brief Answer:
"planter Keratoderma".
Detailed Answer:
Hello,
Welcome and thanks for posting your query to the forum.
I can very well understand your concern for the problem of your husband. It is really very distressing sometimes to find anything which hampers our day to day life.
After analyzing the pictures and correlating with the information provided by you I can make out that presently your husband has the condition of "planter Keratoderma".
To explain you simply- Our skin is multilayered structure and at palmar and planter aspect it 20 times more thicker than the skin at other body areas. whenever any offending factor causes abnormality in the proper functioning then there are formation of small fissures which if not treated in time causes larger cuts and fissure. It may continue for longer time if that factor is not resolved.
There can be multiple causes of this condition including internal tendency to form the cuts or might because of fungal infections or contact to allergic material of shoes and slippers or due to certain other skin conditions too.
In view to help you better I request you to kindly tell me certain important points:
- Are there similar kind of lesions present over palms also.
- Any other site if you can see similar or any other type of skin condition in your husband.
- Had he experienced any boils type of eruptions in the affected area.
- Is there any change in the nails also, if yes then can send the pictures of nails too.
- What is the grade of itching- mild /moderate/ severe.
- Does it gets better by itself or if yo see any seasonal variation.
- Have you gone for any tests or skin examination or biopsy of skin tissues.
- Any other systemic complaints or medications.
- your husband's occupations and what kind shoes and slippers he is wearing daily.
Hope to hear soon form your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY & Sexually transmitted diseases
"planter Keratoderma".
Detailed Answer:
Hello,
Welcome and thanks for posting your query to the forum.
I can very well understand your concern for the problem of your husband. It is really very distressing sometimes to find anything which hampers our day to day life.
After analyzing the pictures and correlating with the information provided by you I can make out that presently your husband has the condition of "planter Keratoderma".
To explain you simply- Our skin is multilayered structure and at palmar and planter aspect it 20 times more thicker than the skin at other body areas. whenever any offending factor causes abnormality in the proper functioning then there are formation of small fissures which if not treated in time causes larger cuts and fissure. It may continue for longer time if that factor is not resolved.
There can be multiple causes of this condition including internal tendency to form the cuts or might because of fungal infections or contact to allergic material of shoes and slippers or due to certain other skin conditions too.
In view to help you better I request you to kindly tell me certain important points:
- Are there similar kind of lesions present over palms also.
- Any other site if you can see similar or any other type of skin condition in your husband.
- Had he experienced any boils type of eruptions in the affected area.
- Is there any change in the nails also, if yes then can send the pictures of nails too.
- What is the grade of itching- mild /moderate/ severe.
- Does it gets better by itself or if yo see any seasonal variation.
- Have you gone for any tests or skin examination or biopsy of skin tissues.
- Any other systemic complaints or medications.
- your husband's occupations and what kind shoes and slippers he is wearing daily.
Hope to hear soon form your side.
With regards,
Dr Sanjay Kanodia
MD-DERMATOLOGY & Sexually transmitted diseases
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor for the quick reply.
Please find the details below:
- Are there similar kind of lesions present over palms also.
- Yes in hands but very less. which disappear on it's owm. but suddenly past few weeks eruptions are more on hands also like boils type of eruptions
- Any other site if you can see similar or any other type of skin condition in your husband.
- Yes found in hands and feet only till now
- Had he experienced any boils type of eruptions in the affected area.
- Yes , Only in hands
- Is there any change in the nails also, if yes then can send the pictures of nails too.
-No
- What is the grade of itching- mild /moderate/ severe.
Itching is not persistent as of now, but itching occurs randomly and is severe.
- Does it gets better by itself or if yo see any seasonal variation.
- Before yes, on hands it was gets better itself not on the feet ,but now a days it is not getting better on hands also, On feet the fissures close and finally one day a bigger fissure is created.
- Have you gone for any tests or skin examination or biopsy of skin tissues.
- No , local dermatologist didnt suggest any test.
- Any other systemic complaints or medications.
- Not taking any other medication .
- your husband's occupations and what kind shoes and slippers he is wearing daily.
- Software engg., Wears something similar to Bata Sandal , has stopped wearing shoes due to the above allegry and also doesnt wear socks.
Wears paragon slippers at home
Also please refer additional images
Please find the details below:
- Are there similar kind of lesions present over palms also.
- Yes in hands but very less. which disappear on it's owm. but suddenly past few weeks eruptions are more on hands also like boils type of eruptions
- Any other site if you can see similar or any other type of skin condition in your husband.
- Yes found in hands and feet only till now
- Had he experienced any boils type of eruptions in the affected area.
- Yes , Only in hands
- Is there any change in the nails also, if yes then can send the pictures of nails too.
-No
- What is the grade of itching- mild /moderate/ severe.
Itching is not persistent as of now, but itching occurs randomly and is severe.
- Does it gets better by itself or if yo see any seasonal variation.
- Before yes, on hands it was gets better itself not on the feet ,but now a days it is not getting better on hands also, On feet the fissures close and finally one day a bigger fissure is created.
- Have you gone for any tests or skin examination or biopsy of skin tissues.
- No , local dermatologist didnt suggest any test.
- Any other systemic complaints or medications.
- Not taking any other medication .
- your husband's occupations and what kind shoes and slippers he is wearing daily.
- Software engg., Wears something similar to Bata Sandal , has stopped wearing shoes due to the above allegry and also doesnt wear socks.
Wears paragon slippers at home
Also please refer additional images
Brief Answer:
Oral retinoids such as Acitretin or Isotretinoin
Detailed Answer:
Hello young lady,
Welcome again to the forum and thanks for your follow up.
After analyzing the complete situation I can make out that you husband has “Palmo-planter keratoderma” after Palmo-planter pustulosis. Though exact cause for this has not been identified but people who have inherited low water retentive capacity in their skin leads to increased trans-epidermal water loss into the atmosphere and formation of pustules and then cracks.
Repeated washing with soaps exacerbates the condition leading to painful cracks and fissures. It can occurs in smokers, so do let me know if your husband smokes or not. If yes then ask him to quit smoking.
In a precise therapy I start high potency steroid cream such as halobetasol and then shift slowly to lower potency serially.
Additionally I suggest you to do saline compression. For the same you can take half bucket of warm water, put a pinch of salt in it and dip your leg for 15 minutes two times in day. This will improve the hydration as well as helps in fast renewal of dead skin.
An important point is proper hydration- your kind of cases requires a regular moisturization by paraffin gelly for multiple times a day. Moisturisers should be applied as frequently as possible. This will help in reducing the cuts and give a natural feel to the skin. Extreme dryness can lead to chapping and cracking of the palms and feet.
In my patients if despite all these measures if the patient is not improving then I usually start with oral retinoids. These are the most effective remedy in plantar keratoderma and pustulosis. I prescribe oral retinoids such as Acitretin or Isotretinoin after thorough evaluation.
In “Palmo-planter keratoderma” and Palmo-planter pustulosis the treatment requires long time. You can ask your treating dermatologist if he/she can help you for the exact guidance of the suggestions given above.
I hope these informations will help you. I will be glad to guide you any further.
With regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Oral retinoids such as Acitretin or Isotretinoin
Detailed Answer:
Hello young lady,
Welcome again to the forum and thanks for your follow up.
After analyzing the complete situation I can make out that you husband has “Palmo-planter keratoderma” after Palmo-planter pustulosis. Though exact cause for this has not been identified but people who have inherited low water retentive capacity in their skin leads to increased trans-epidermal water loss into the atmosphere and formation of pustules and then cracks.
Repeated washing with soaps exacerbates the condition leading to painful cracks and fissures. It can occurs in smokers, so do let me know if your husband smokes or not. If yes then ask him to quit smoking.
In a precise therapy I start high potency steroid cream such as halobetasol and then shift slowly to lower potency serially.
Additionally I suggest you to do saline compression. For the same you can take half bucket of warm water, put a pinch of salt in it and dip your leg for 15 minutes two times in day. This will improve the hydration as well as helps in fast renewal of dead skin.
An important point is proper hydration- your kind of cases requires a regular moisturization by paraffin gelly for multiple times a day. Moisturisers should be applied as frequently as possible. This will help in reducing the cuts and give a natural feel to the skin. Extreme dryness can lead to chapping and cracking of the palms and feet.
In my patients if despite all these measures if the patient is not improving then I usually start with oral retinoids. These are the most effective remedy in plantar keratoderma and pustulosis. I prescribe oral retinoids such as Acitretin or Isotretinoin after thorough evaluation.
In “Palmo-planter keratoderma” and Palmo-planter pustulosis the treatment requires long time. You can ask your treating dermatologist if he/she can help you for the exact guidance of the suggestions given above.
I hope these informations will help you. I will be glad to guide you any further.
With regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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