Palmoplantar keratoderma

Palmoplantar keratoderma is a group of conditions causing abnormal thickening of the skin on the palms of the hands and soles of the feet. It can be inherited or acquired, and severity ranges from mild scaling to painful, fissured skin that affects walking and hand use.

Inherited forms result from mutations in genes controlling skin cell structure and turnover, while acquired forms can be triggered by skin conditions like eczema or psoriasis, friction, certain medications, or underlying systemic disease. Identifying which type you have guides the right treatment approach.

Symptoms include thickened, hardened skin on the palms and soles, which may crack, become painful, and sometimes develop a yellowish colour. Some inherited forms also affect the nails, hair or other areas of skin.

It is rarely dangerous but can be genuinely disabling, causing pain, difficulty walking or gripping objects, and increased risk of skin infection through cracked skin. A minority of genetic forms are linked to other health issues, such as heart or hearing problems, that need separate assessment.

Many forms are inherited, often in an autosomal dominant pattern, though acquired forms linked to other skin conditions or external factors are not genetic. Genetic testing can help clarify the specific inherited subtype if needed.

Inherited forms cannot be cured outright since they stem from a genetic skin structure issue, but regular skin care can keep symptoms well controlled. Acquired forms may improve or resolve if the underlying trigger, such as an associated skin condition, is treated.

Treatment typically involves regular use of emollients and keratolytic creams (containing urea or salicylic acid) to soften and reduce thickened skin, along with mechanical removal of excess skin by a podiatrist or dermatologist. Severe cases sometimes benefit from oral retinoid medication.

Regular emollient and keratolytic use often improves comfort within a few weeks, but ongoing daily skincare is usually needed long-term to keep symptoms controlled, particularly for inherited forms. Stopping treatment often leads symptoms to return.

Inherited forms typically begin in infancy or childhood, are lifelong, and often run in families, while acquired forms develop later in life and are linked to another skin condition, medication or systemic illness. Identifying the type helps target treatment at the underlying cause where possible.

Thickened, painful or cracking skin on the palms or soles that isn't improving with basic moisturising should be assessed by a dermatologist. Private dermatology consultations can typically be arranged within about two weeks, considerably faster than typical NHS waiting times.