Palmoplantar Keratoderma: A clinico-Epidemiological Study

BACKGROUND:
palmoplantar keratoderma (PPK) is an umbrella term for any form of persistent thickening of the epidermis at palmar and/or plantar surfaces, and includes hereditary and acquired conditions. PPK can manifest clinically as diffuse, focal and punctate forms.
OBJECTIVE:
To study the frequency, clinical features and etiological correlation of hereditary and acquired PPK.
PATIENTS AND METHODS:
The study is observational, descriptive and cross-sectional. It was conducted at the Dermatology Center, Medical City, Baghdad Teaching Hospital, during the period from February 2019 to April 2020 patients with hereditary and acquired PPK were included in this study. Detailed history, clinical examinations and investigations when appropriate were done to reach the diagnosis.
RESULTS:
Two hundred and eighty patients with PPK were enrolled in this study; 138 (49.3%) were males and 142 (50.7%) were females. Patients were divided into 2 groups; group A (hereditary PPK) included 22 patients (8%) with mean±SD age of 17.63±13.46 years. Group B (acquired PPK) included 258 patients (92%) with mean ±SD age of 31± 20.43 years. Both palms and soles were more commonly affected than palms or soles alone. The most common morphological type was focal (51%) followed by diffuse in (47%). The most common diagnosis in group A was ichthyosis (7 patients, 31.81%), while the most common cause in group B was psoriasis (116 patients, 44.96%). Itching was the predominant symptom in both groups. PPK was seen among housewives, students and manual workers. Family history was positive in 12 (54.55%) patients in group A and 82 (32%) patients in group B.
CONCLUSION:
PPK is frequently encountered among Iraqi patients. Psoriasis was found to be the most common cause. Clinically the most common type was focal. Itching was the most common reported symptom.

Keywords

References

1. Guerra L, Castori M, Didona B, Castiglia D, Zambruno G. Hereditary palmoplantar keratodermas. Part I. Non‐syndromic palmoplantar keratodermas: classification, clinical and genetic features. Journal of the European Academy of Dermatology and Venereology. 2018;32:704–19.

2. Dev T, Mahajan VK, Sethuraman G. Hereditary palmoplantar keratoderma: A practical approach to the diagnosis. Indian dermatology online journal. 2019;10:365.

3. Kimyai-Asadi A, Kotcher LB, Jih MH. The molecular basis of hereditary palmoplantar keratodermas. Journal of the American Academy of Dermatology. 2002;47:327–46.

4. Fu DJ, Thomson C, Lunny DP, Dopping-Hepenstal PJ, McGrath JA, Smith FJ, et al. Keratin 9 is required for the structural integrity and terminal differentiation of the palmoplantar epidermis. Journal of Investigative Dermatology. 2014;134:754–63.

5. Has C, Technau-Hafsi K. Palmoplantar keratodermas: clinical and genetic aspects. Journal der Deutschen Dermatologischen Gesellschaft. 2016;14:123.

6. Guerra L, Castori M, Didona B, Castiglia D, Zambruno G. Hereditary palmoplantar keratodermas. Part II: syndromic palmoplantar keratodermas–Diagnostic algorithm and principles of therapy. Journal of the European Academy of Dermatology and Venereology. 2018;32:899–925.

7. Patel S, Zirwas M, English JC. Acquired Palmoplantar Keratoderma. Am J Clin Dermatol. 2007 Feb 1;8:1–11.

8. Bodemer C, Steijlen P, Hautier JM, O’Toole E. Treatment of hereditary palmoplantar keratoderma: a review by analysis of the literature. British Journal of Dermatology. 2020;in print.

9. Murthy SC, Raghu TY, Suresh T. A study of palmoplantar keratodermas in South India. International journal of dermatology. 2008;47:762–4.

10.Puri N. A study on palmoplantar keratodermas in childhood in a district hospital. Indian Journal of Paediatric Dermatology. 2017;18:183.

11.Al-Hamami HR, Noaimi AA, Al-Waiz MM, Al-Kabraty AS. Frequency of genodermatoses among Iraqi patients. The Iraqi Postgraduate Medical Journal. 2010;9:62–7.

12.Mahajan P, Gharpuray M, Kulkarni V. Clinical and histopathological study of palmoplantar keratoderma. Indian Journal of Dermatology, Venereology, and Leprology. 1994;60:258.

13.Kodali S. A clinico-histopathological study of acquired palmoplantar keratoderma in a rural-based tertiary hospital. Journal of Evolution of Medical and Dental Sciences. 2014;3:8500–6.

14.Agarwal P, Nijhawan M, Mathur D. Clinicopathological study of hyperkeratotic lesions of palms and soles: an observational study. International Journal of Scientific Study. 2014;1:19–23.

15.Dash M, Sahu MK, Padhi T. Clinico-pathological correlation of acquired palmoplantar hyperkeratotic disorders. J Evid Based Med Healthc 2018; 5:1942-47.

16.Chopra A, Gill S. Hyperkeratosis of palms and soles: Clinical study. Indian Journal of Dermatology, Venereology, and Leprology. 1997;63:85.