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Oral psoralen photochemotherapy (PUVA) was found to be effective in five patients with chronic hyperkeratotic dermatitis of the palms. Relapses may occur but they respond well to retreatment. [ABSTRACT FROM AUTHOR]

Palmoplantar keratoderma (PPK) is a condition where the patient has thick, hard skin on the palms and soles. It can cause considerable discomfort and impairment of function. This problem is sometimes inherited (hPPK). There are many varieties of hPPK which are all uncommon. They show considerable variation in presentation, severity, genetics and associated abnormalities. This study is an international collaboration between four members of the European Network for Rare Skin Diseases. Their aim was to search the literature published since 2008 looking for evidence to support the use of different treatments for hPPK. Initially they found 20,409 papers on the subject. However, after applying exclusion criteria this was reduced to a total of 42 publications, mainly of small case series and single case reports. The level of evidence to support any particular treatment was weak. The most effective treatment was the use of oral retinoids (Vitamin A derivatives). However, they were not universally efficacious and their tolerability varied. Local therapy in the form of creams to soften and break down the surface hard skin layer were helpful in most situations. Podiatrists play an important role in providing physical treatments such as paring of hard skin, providing protective insoles and appropriate footwear. Newer, experimental treatments based on increased understanding of the cellular mechanisms involved in hPPK are under investigation. Because hPPK syndromes can involve other body systems such as the teeth, eyes and ears, the authors stressed the importance of a multidisciplinary approach in managing these patients. Linked Article: Bodemer et al. Br J Dermatol 2021; 184:393–400. Linked Article: Bodemer et al. Br J Dermatol 2021; 184:393–400. [ABSTRACT FROM AUTHOR]

Tripe palms are thickened, moss-like or velvety textured exaggerations of the normal dermatoglyphics. The disease belongs to the spectrum of papulosquamous paraneoplastic syndromes. Although suspected, the role of transforming growth factor-alpha (TGF-alpha) has not been clearly established. A 54-year-old man with systemic mastocytosis presented with thickening and darkening of the palms and soles. We performed skin biopsies for light microscopy (including toluidine blue), in situ hybridization and double labelling, and determination of serum tryptase, histamine and TGF-alpha levels. Toluidine blue stained the mast cells that had massively infiltrated the dermis. Tripe palm samples showed extensive hyperkeratosis. The TGF-alpha probe reacted strongly with the mast cells that also reacted with the antitryptase monoclonal antibody. Elevated tryptase, histamine and TGF-alpha levels prior to interferon-alfa administration decreased under treatment. The demonstration of TGF-alpha in infiltrating mast cells, the clinical regression of tripe palms and the lowering of the serum level and the mast cell molecular signal of the cytokine when systemic mastocytosis was controlled by interferon-alfa, suggest a key role for TGF-alpha in this cutaneous paraneoplastic syndrome.

PUVA therapy successfully cleared various dermatoses mainly confined to the palms and soles in 18 of 20 patients treated. The conditions treated were: plaque-type psoriasis, pustular psoriasis, endogenous eczema and persistent palmoplantar pustulosis. Seventeen patients were treated in a controlled study of PUVA, therapy versus no treatment at all and in 16 of these patients the disease was cleared in the PUVA-treated areas while the untreated areas remained unchanged or deteriorated. Twelve of the 18 patients were maintained in a clear state by continued maintenance PUVA treatment over 6-31 months while 3 patients had a spontaneous remission and are free of disease off all treatment. [ABSTRACT FROM AUTHOR]

Thirty two adult patients who presented with a sharply marginated, hyperkeratotic dermatitis of the palms (HDP), but with no skin lesions elsewhere, have been re-examined approximately 10 years later. Topical treatments had had limited effect. The morphological appearance and localization had remained unchanged, except in two individuals who were free from symptoms. One had developed psoriasis. The incidence of atopic disease and psoriasis in first degree relatives did not differ from that in control subjects. Mycological cultures and patch tests were negative. Serum IgE was normal. Skin biopsies in nine patients all revealed a chronic spongiotic dermatitis. HDP emerges as a distinct and separate disease entity. [ABSTRACT FROM AUTHOR]

Identical twin boys with palmoplantar keratoderma were treated by total excision of the skin of one sole to the level of the plantar aponeurosis, followed by grafting. The hyperkeratosis did not recur on the treated sole, and the keratoderma of the untreated soles and of the palms disappeared. In both cases the keratoderma eventually recurred on the palms and on the untreated sole. [ABSTRACT FROM AUTHOR]

Poldine methosulphate (" Nacton ") inhibits sweating. Poldine is readily absorbed percutaneously, absorption being increased by occlusion. Complete inhibition of sweating for 2-3 days is obtained on all areas, except for the palms, soles, periungual regions and axillae, by the topical application of poldine. Some sweat suppression persists for up to one week. Sweating from the palms, soles, periungual regions and axillae is diminished but not completely suppressed. The decreased effectiveness of poldine at these sites is possibly due to the increased activity of sweat glands in these areas or to decreased percutaneous absorption. Poldine injected locally into the palms completely inhibits sweating. [ABSTRACT FROM AUTHOR]

The article presents a case of a 17-year-old Dutch boy who developed transgradient palmoplantar keratosis on his palms and soles shortly after birth. The patient has been diagnosed of having Mal de Meleda (MDM), based on the clinical symptoms. The finding shows that since the identification of mutations in ARS component B gene as the cause of MDM, a limited number of mutations have been identified.

In a double-blind controlled study of patients with pustular psoriasis of palms and soles who were allocated at random to etretinate or placebo, we found that etretinate improved the condition as assessed by pustule count and overall clinical response. Side-effects occurred but were accepted by the patients in the short-term. The clinical usefulness of etretinate in this condition will depend on time to relapse, and whether this can be prevented or postponed by continuous treatment. Toxicity in the long-term will also be important.

The article highlights various dermatological case studies, presented at the North of England Dermatological Society on May 10, 1966. This is the case study of a mother and daughter aged 46 and 18 respectively. Mother first developed nodules on knees, ankles, toes, soles of feet and buttocks in late adolescence. Most of the nodules were slightly tender and increased slowly in size but none exceeded 1-0 cm. in diameter. Daughter first noticed at the age of 14 painless nodules on fingers and hands (including palms) and solitary swellings on dorsum of right foot and on left thigh.

The article discusses the case reports related to skin disease in July 1985 issue of the "British Journal of Dermatology." One of the case includes "Erythrokeratolysis hiemalis: Oudtschoorn skin," where the patient has a history of blisters and scaling on palms and soles. The condition is asymptomatic and has not improved in the summer months. Her paternal great -great-grandmother came from Oudtschoorn in South Africa. Although her father is unaffected many members of his family have suffered from this complaint. The child presents the typical features of Oudtschoorn skin except for her lack of improvement in the summer months. This may be explained by the differences in climate between Britain and South Africa.

The article presents a case report of two patients suffering from epidermolysis with pigmentation and palmar and plantar keratoses. The 32-year-old patient had mottled pigmentary changes over the trunk and limbs with keratoses on the palms and soles. His mother and father were normal. He has one sister who is also normal. However, his only daughter is affected. This father and daughter have a condition which is hard to classify. It seems possible that it is an unusual variant of epidermolysis bullosa with keraioses and pigmentation, but the Naegeli-Franceschetti-Jadassohn syndrome has also been considered.

Background Aquagenic keratoderma is an uncommon condition that occurs after brief water exposure. An association with cystic fibrosis has been suggested. Histopathology is considered to be nonspecific. Objectives To describe the microscopic findings in seven of 12 new patients and compare the histopathological results of the lesions which appeared on the palmar skin after immersion into water with normal skin. Patients and methods Nine female and three male patients (mean age 27 years) were collected prospectively and evaluated for common demographic, clinical and histopathological features. Results Lesions were located on only the palms in seven patients; the soles were involved in two patients; and one patient had involvement of the dorsal aspect of the hands. One patient had a similar family history. None of the patients reported associated conditions. Genetic studies revealed heterozygosis for mutation in the cystic fibrosis gene in two patients. The most specific histopathological findings were: orthohyperkeratosis with increased thickness and abnormal staining of the stratum corneum; dilated acrosyringia and dermal eccrine ducts with hyperplasia of eccrine glands, clear cell change and vacuolation; increased capillaries around and adjacent to the eccrine glands. A skin biopsy taken after restoration of normal skin with drying revealed a normal stratum corneum with a physiological uniform stain and normal thickness without further evidence of dilation of acrosyringia or dermal eccrine ducts. Incipient dilation of the secretory and ductal structures was also observed in a transitional area between the involved and the clinically normal skin of the palms. Conclusions Aquagenic keratoderma may be associated with a heterozygous mutation in the cystic fibrosis gene. Although the diagnosis is a clinical one, histopathology is useful and may reveal some characteristic diagnostic clues. Aquagenic pseudokeratoderma seems to be a more appropriate term to name it. [ABSTRACT FROM AUTHOR]