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What Is Severe Hyperkeratosis?

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Severe hyperkeratosis is a thickening of the outer layer of the skin, often associated with the presence of an abnormal quantity of keratin. It can be caused by a variety of conditions including chronic eczema, palmoplantar psoriasis, paraneoplastic acrokeratosis, reactive arthritis such as reiter’s syndrome and superficial fungal infection.

Symptoms of Severe Hyperkeratosis

Symptoms include significant heavy callus on the bottom of the feet which can crack and cause considerable discomfort and will occasionally lead to infection. It can also affect the toenails causing thickening and crumbling and in some cases it can affect the hands.


A person should see a dermatologist for a correct diagnosis.


Treatment is dependent on the cause of the hyperkeratosis and research suggests it can be difficult to treat.

Research shows 40% urea cream should be applied 2-3 times a day. There is also evidence to support the use of the retinoid acitretin but it is generally only used in severe resistant cases due to the side effects. It works by inducing keratinocyte differentiation and reduces epidermal hyperplasia, leading to slower cell reproduction.

When hyperkeratosis is caused by palmoplantar psoriasis the following treatment is indicated;

Coal Tar therapy which has a anti-inflammatory, antibacterial and anti mitotic effect. Tar preparations are useful in reducing the potency of topical glucocorticoids in long term maintenance therapy of psoriasis.

Soaking the area in water bi weekly can cleared mild to moderate psoriatic lesions. It has also shown to reduce edema.

Use of emollients, 40% urea cream ideally is the most effective product.

Phototherapy and systemic drugs.

An effective regimen is to apply calcipotriene in the morning and a corticosteroid in the evening for two weeks. Then begin a maintenance regimen using corticosteroids twice daily on weekends and calcipotriene twice a day on weekdays. Application for 6-8 weeks normally sees an reduced plaque reduction of 60-70%.

Resolution of Severe Hyperkeratosis

Resolution of this skin condition is a tricky one, but can occur with the correct treatment regime under the specialist care from a dermatologist.Sarah

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Shop 2/17-19 East Parade
Sutherland, NSW 2232

Tel: 02 9542 3491