Palmoplantar keratodermas (PPKs) are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. What are the other Names for this Condition? (Also known as/Synonyms). Acquired Palmoplantar Keratoderma; Acquired PPK. Paraneoplastic palmoplantar keratoderma (PPK) is an acquired dermatosis that presents with hyperkeratosis of the palms and soles in association with visceral.

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Acquired palmoplantar keratoderma.

The first step should include a comprehensive history and a physical examination, including a complete skin examination. The vast majority are associated with adenocarcinoma of the stomach, but other acqired sometimes found include other GI tract tumours, lung, uterus, ovaries, and urinary tract Tripe palms – the appearance differs to that of keratoderma with thickened velvety palms that have the appearance of tripe.

The palms of the hands may be affected with discrete, centrally placed lesions. The cutaneous features usually pre-date the diagnosis of the cancer. Keratoderma can be inherited, acquired, and rarely, paraneoplastic ie secondary to an internal malignancy.

There is usually a well-defined erythematous border The two conditions vary in their histological features Several others types have been described. Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task.

To facilitate such evaluations, this review categorizes the acquired PPKs as: Any image downloaded must only be used for teaching purposes and not for commercial use.

If findings are consistent with a hereditary keratoderma, then a genetics consultation should be considered. In terms of treatment, the most successful results occur when the underlying etiology is diagnosed and treated. All named individuals and organisations maintain copyright for the relevant images. Keratoderma of the soles and acanthosis nigricans of the hands in a patient with bladder carcinoma.


It is often associated with acanthosis nigricans AN. Web Design – Mode Ten Designs. Axial CT images showing multiple polypoidal enhancing mass lesions with surface calcifications, in the urinary bladder. Website author — Dr Tim Cunliffe read more.

Some people with focal palmoplantar keratoderma also have abnormalities of the fingernails and toenails There are several inherited typeswhich are all rare.

Palmoplantar keratoderma | Primary Care Dermatology Society | UK

It is associated with squamous cell carcinoma of the upper aerodigestive tract oral cavity, pharynx, larynx, oesophagus. In order to avoid the possibility of overlooking an underlying etiology and to eliminate excessive testing, we present an algorithm for assessing patients presenting with acquired PPK.

All are rare Epidermolytic keratoderma Vorner’s keratoderma and non-epidermolytic keratoderma Thost-Unna keratoderma are two of the best described forms Both are autosomal dominant Clinically the features can be indistinguishable with the development, usually in infancy, of diffuse, yellow, thickened skin affecting the palms and soles.

It usually affects the sole of the feet around the margins of the heel and under the metatarsal heads. Palmoplantar keratodermas PPKs are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles.

If no pertinent findings are identified after a history and a physical examination, laboratory and radiology studies should be undertaken in a systematic, logical fashion. Any findings suggestive of underlying conditions should be aggressively evaluated and treated. Keratoderma may be hereditarywith symptoms presenting in early childhood, or acquired when it presents in later life.

Palmoplantar keratoderma is a term used to define a marked thickening of the skin on the palms and soles, either as a focal entity, or diffuse. Clinical classification Keratoderma can be defined by its clinical appearance, although there is often overlap: If no such etiology is evident, then conservative treatment options include topical keratolytics urea, salicylic acid, lactic acidrepeated physical debridement, topical retinoids, topical psoralen plus UVA, and topical corticosteroids.


Notice and credit must be given to the PCDS or other named contributor. Rarely keratoderma can be associated with malignancy. In cases where tripe palms occur without AN, lung cancers are usually responsible.

Palmoplantar keratoderma

Occasionally keratoderma can affect other parts of the body It can be difficult to differentiate between the different types of keratoderma, however, the management principles are similarand as such the key diagnostic elements are to exclude the rare malignant or other systemic causes. Three stages have been described: They can be very effective for some patients, but cannot be used in fertile women due to their teratogenicity. This chapter provides a practical overview of keratoderma, and is set out as below: A painful paronychia develops with no evidence of bacterial or fungal infection.

Please click on images to enlarge or download. Please follow this link if you have any high-quality images that you can contribute to the website. Etretinate and acitretin have also shown some success as alternative treatments in recalcitrant cases.

This website is non-profit and holds the images for educational purposes only. Aetiology Clinical findings Images Investigations Management.