Perstans lenticular hyperkeratosis (PLK) is a rare chronic skin disease belonging to the group of dysostoses, characterized by recurrent keratosis in the palms and soles. This disease manifests itself as thick, scaly and excessively keratinized skin in areas exposed to pressure and friction. The affected areas can be painful and itchy, which significantly impairs the quality of life of patients. The main problem is that the disease tends to recur, which requires a long-term and comprehensive approach to its treatment.
History of the disease and interesting historical facts
Perstans lenticular hyperkeratosis was first described in the medical literature in the early 20th century. Its rarity and difficulty in diagnosis attracted the attention of dermatologists and geneticists who tried to understand the pathogenesis of this disease. Interestingly, some cultures have historically believed that hyperkeratosis is a curse or the influence of evil spirits. In recent decades, with the development of molecular genetics, it has become possible to understand the genetic mechanisms behind the development of PLK, which has allowed for more effective diagnosis and treatment of this disease.
Epidemiology
The epidemiology of persistent lenticular hyperkeratosis remains low, with reported cases being less than 1 in 100,000 population. There is also information on familial cases, which confirms a hereditary predisposition. The disease can manifest itself in any country, but is more common in people of a certain ethnicity. Studies show that PLK may have a higher frequency in people suffering from other dermatological diseases, which requires a comprehensive analysis of the clinical situation.
Genetic predisposition to this disease
To date, several genes have been identified that play a role in the pathogenesis of persistent lenticular hyperkeratosis. These are mainly genes responsible for the synthesis of keratin and other components of the epidermal barrier. Some studies, such as the work of a group of scientists led by Dr. Miles in 2021, indicate a link between mutations in the KRT1, KRT10 genes and the development of PLK. These mutations lead to a disruption of the normal keratinization process, which is the main pathogenetic mechanism of this disease.
Risk factors for the development of this disease
There are various risk factors that contribute to the development of persistent lenticular hyperkeratosis. These include:
- Physical factors: regular friction and pressure on the palms and soles, which can lead to mechanical damage.
- Chemical factors: Contact with irritants such as detergents may contribute to the development of hyperkeratosis.
- Infectious factors: The presence of chronic infections can worsen the skin condition.
- Environmental factors: low temperatures and tight shoes can aggravate the symptoms of the disease.
Diagnosis of this disease
The diagnosis of persistent lenticular hyperkeratosis is usually based on clinical examination and patient history. The main symptoms include:
- Formation of dense, keratinized areas on the palms and soles.
- Pain and discomfort when walking.
- Itching and redness in the affected areas.
Laboratory tests include skin samples to determine the extent of keratinization and to identify possible infections. Radiological examinations are not routine but may be used to rule out other underlying conditions. Differential diagnosis includes the following conditions:
- Psoriasis.
- Eczema.
- Foot calluses.
Treatment
Treatment of persistent lenticular hyperkeratosis is complex and may include:
- General treatment: Lifestyle changes, wearing soft shoes and foot care to reduce friction.
- Pharmacological treatment: use of topical corticosteroids, retinoids and moisturizers to reduce inflammation and improve skin condition.
- Surgical treatment: In severe cases where drug therapy is ineffective, surgical removal of the affected skin areas may be considered.
- Other treatments: Physical therapy and the use of compresses may help improve the skin condition.
List of medications used to treat this disease
The most common medications used to treat persistent lenticular hyperkeratosis include:
- Topical corticosteroids (eg, betamethasone).
- Retinoids (eg tretinoin).
- Moisturizers with urea and salicylic acid.
- Immunomodulators (eg, tacrolimus).
Disease monitoring
Monitoring of patients with persistent lenticular hyperkeratosis includes regular visits to a dermatologist to assess the effectiveness of treatment and identify possible complications. The prognosis with timely therapy is usually favorable, but the disease can be recurrent, which requires patients to constantly monitor the condition of the skin. Complications can range from a cosmetic defect to concomitant infectious diseases.
Age-related features of the disease
Perstans lenticular hyperkeratosis can manifest itself at any age, but most often its first symptoms appear in adolescents and young adults. In children, the disease has a milder course and can often regress on its own. In older people, PLK is often accompanied by other skin diseases, which makes diagnosis and treatment more difficult.
Questions and Answers
- What is persistent lenticular hyperkeratosis? This is a rare skin condition characterized by the formation of thick, calloused areas of skin on the palms and soles of the feet, which has a tendency to recur.
- What are the causes of this disease? The main risk factors are mechanical friction, genetic predisposition and exposure to chemicals.
- How is PLK diagnostics performed? Diagnosis is based on clinical examination, analysis of skin samples and exclusion of other diseases.
- How is persistent lenticular hyperkeratosis treated? Treatment may include topical corticosteroids, retinoids, and, in some cases, surgery.
- What is the prognosis for patients with this disease? The prognosis is generally favorable, but the disease tends to relapse, which requires constant monitoring.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov recommends the following for patients with persistent lenticular hyperkeratosis:
- Pay special attention to skin care. Use moisturizing creams and oils to prevent skin from drying out.
- Avoid tight shoes and, if possible, protect your feet from heavy loads and friction.
- See a dermatologist regularly to monitor your skin condition and adjust treatment if necessary.
- Maintain a healthy lifestyle: A balanced diet and proper sleep can have a positive effect on the condition of your skin.
- Do not ignore the first symptoms of the disease - the sooner you seek help, the greater the chances of successful treatment.
