Hyperkeratosis (hyperkeratosis) is a skin condition in which the patient suffers from keratinization of the skin in certain skin areas, causing the skin to thicken. This happens as a result of inflammation, as a protective response to pressure or as a result of a genetic condition, which causes increased production of keratin. Hyperkeratosis is a sign of various skin diseases, each with its own symptoms. Most forms of hyperkeratosis can be treated with medication. Many forms of thickened skin can also be prevented.

• Causes: Thickening of the stratum corneum
• Risk factors of thickened skin

• Diseases
• Environmental factors

• Symptoms

• Actinic keratoses
• Eczema
• Calluses
• Epidermolytic hyperkeratosis
• Follicular hyperkeratosis
• Lichen planus
• Corns
• Plaque psoriasis
• Seborrheic keratoses
• Warts

• Alarm signals
• Diagnosis and examinations
• Treatment of hyperkeratosis
• Prognosis of skin condition
• Prevention of keratinization of the skin

Causes: Thickening of the stratum corneum

The fingernails, hair and skin contain keratin (tough, fibrous protein). In some cases, the body produces extra keratin, which causes a thickening of the stratum corneum (upper layer of the epidermis). Pressure-related hyperkeratosis occurs due to excessive pressure, inflammation or irritation of the skin. The skin responds to this by producing extra layers of keratin to protect the damaged skin areas. Non-pressure-related keratosis occurs on non-irritated skin, possibly due to genetic factors.

Risk factors of thickened skin

Diseases

Chronic inflammation or infection may cause the body to produce more keratin as a protective measure, resulting in hyperkeratosis. Leukoplakia (thickened white patches in the mouth and cheeks) is another risk factor for keratinization of the skin.Sun exposure is a risk factor for hyperkeratosis / Source: Blueeve, Pixabay

Environmental factors

Some environmental factors increase the risk of hyperkeratosis:

• exposure to the harmful UV rays of sunlight
• contact with chemicals
• a history of smoking or chewing tobacco use
• frequent friction or pressure
• walking barefoot
• intensive manual labor

Symptoms

Hyperkeratosis is associated with a potentially wide range of symptoms. However, all symptoms involve a rough or irregular area of skin that feels different from the surrounding skin.

Actinic keratoses

Exposure to the ultraviolet rays of sunlight causes flat, rough, sandpaper-like spots on the skin. Sometimes the lesions are only a few millimeters in size. The lesions of actinic keratoses are a potential precursor to skin cancer.

Eczema

This chronic skin condition causes red skin, dry skin, flaky skin, itchy skin and small blisters. Usually the rash appears in patches (plaques) or else the lesions are visible as small bumps on the skin. Pain is rare with eczema. Eczema results from allergies, irritating chemicals and other factors.

Calluses

A callus is an area of thickened skin usually found on the feet. Occasionally calluses also develop on the fingers. Calluses are usually uniform in shape. In some cases, callus formation is accompanied by pain.

Epidermolytic hyperkeratosis

This condition causes very red skin and severe blistering of the skin from birth. As the baby ages, areas of thickened skin (hyperkeratosis) develop, especially on the joints. Some other hereditary conditions may also cause hyperkeratosis.

Follicular hyperkeratosis

Follicular hyperkeratosis causes excessive production of keratin in the hair follicles. The skin condition causes red, rough, cone-shaped, raised pimples on the skin. Scaling and itching are possible. Vitamin deficiencies such as vitamin A deficiency, vitamin B deficiency, vitamin E deficiency and essential fatty acid deficiency are risk factors for this disease.

Lichen planus

Lichen planus causes a white spot on the inside of the mouth. Another possible feature is an itchy, violet, scaly patch elsewhere on the skin. Occasionally even the genitals are affected. Lichen planus may be the result of an abnormal immune system response.

Corns

A corn is an often painful lesion that usually develops on or between the toes. Corns usually have a central lesion of very hard keratin with a slightly softer outer ring of hard tissue.

Plaque psoriasis

Plaque psoriasis causes an excessive accumulation of skin cells. This causes the patient to experience an often silvery, flaky rash on the affected areas.

Seborrheic keratoses

Seborrhoeic keratoses cause small, benign brown to black skin growths. They appear on the face, torso, arms or legs. Seborrhoeic hyperkeratoses are very common and have no known cause as of October 2020.

Warts

Warts are small bumps on the skin of, for example, the hands or feet. These are the result of an infection with the human papillomavirus (HPV). The spread of warts usually occurs through direct contact, but also with contaminated objects such as walking barefoot in a gym or by wearing the shoes of an infected patient.

Alarm signals

When pain or discomfort arises, a visit to the doctor is necessary. Medical attention is also required if there are signs of a skin infection (red skin, warm skin, swollen skin or pus-filled bumps).

Diagnosis and examinations

Physical Examination Sometimes hyperkeratosis plaques closely resemble signs of skin cancer, causing patients to visit the doctor for a checkup of the thickened skin areas. The doctor reviews the patient’s medical history and determines a possible underlying risk factor for the hyperkeratosis.Diagnostic examination A doctor sometimes also uses imaging tests to detect possible problems with the bone structure. These tests also make it possible to detect the presence of tumors on or around the hyperkeratotic areas. Another diagnostic tool is a biopsy, in which the doctor takes a skin sample and has it examined microscopically for the presence of cancer cells or other cell abnormalities.

Treatment of hyperkeratosis

If a patient experiences a condition that leads to removable lesions (for example warts), then medical treatment is certainly necessary. The treatments for hyperkeratosis depend on the form. The doctor uses cryotherapy (treatment via freezing) or else he performs laser therapy (evaporation of the wart). In psoriasis, the doctor uses substances that break down the keratin to scrape off the thickened skin. The doctor also sometimes prescribes medications to treat hyperkeratotic areas, such as corticosteroid creams to treat eczema or lichen planus.

Prognosis of skin condition

Cornification of the skin exists in many painless forms. Some forms are accompanied by warts and calluses, but these are easy to treat. Other forms of hyperkeratosis are also usually easy to treat. How long a form of hyperkeratosis is present depends on the cause. Corns and calluses persist with poorly fitting shoes. Warts often disappear on their own, although this may take months to years. Actinic keratoses or seborrheic keratoses are chronic in nature; they do not go away without treatment. Hereditary forms of hyperkeratosis are also present for life.The use of sunscreen is recommended / Source: Dimitrisvetsikas1969, Pixabay

Prevention of keratinization of the skin

People wear comfortable, well-fitting shoes to avoid friction and irritation. Wearing special plasters over corns or calluses provides further protection. It is also not recommended to go barefoot in places where there may be mold (changing rooms, gyms or swimming pools). Furthermore, people avoid risk factors for eczema, such as smoking, dry air, strongly scented soaps, harsh chemicals, or extremely hot or cold temperatures. Avoiding substances that cause an allergy is also necessary, such as not coming into contact with pet dander and pollen. These may cause skin inflammation. In addition, it is useful to use moisturizers for dry, flaky skin. Wearing sunscreen with a sun protection factor of at least 30 is necessary whenever the person goes outside. Finally, wearing protective clothing such as a hat or long sleeves provides protection against actinic keratosis. review