What is hyperkeratotic eczema?
Hyperkeratotic, or tylotic, eczema is a persistent form of hand eczema that causes thick, hard, scaly areas on the palms and the flexor surfaces of the fingers. Deep, painful cracks can form within the thickened skin. Burning and pain are often more troublesome than itching. Similar changes sometimes affect the soles.
Causes and diagnosis
The exact cause is not always clear. Repeated exposure to water, detergents, solvents, friction or other irritants can worsen the condition, while smoking may be associated in some people. Contact allergy is not usually the main cause, but it can coexist. A clinician may need to distinguish it from psoriasis, fungal infection, inherited keratoderma and other causes of thick palms. Examination, fungal scrapings and patch testing may be used when the diagnosis is uncertain.
Treatment
Frequent application of a rich, fragrance-free ointment helps restore the skin barrier. A clinician may prescribe a potent topical corticosteroid for limited courses; use it only in the amount and duration advised. Ointments containing urea or another keratolytic can soften excessive scale, although they may sting in open cracks. Persistent disease may be treated by a dermatologist with ultraviolet light therapy or systemic medicine such as a retinoid or another immune-modifying treatment. These options require screening and monitoring, and retinoids have strict pregnancy precautions.
Protecting the hands
Use lukewarm water and a gentle soap substitute, dry carefully and moisturise after washing. Wear suitable protective gloves for wet work or chemicals, with clean cotton liners if sweating occurs, and remove them regularly. Avoid direct contact with cleaning agents and do not peel thick skin. Cover painful fissures with an appropriate dressing and treat infection promptly. Even with careful treatment, this type of eczema can be long-lasting and may relapse.
When to see a doctor
Arrange an assessment for persistent thickening or cracks, an uncertain diagnosis, or eczema that affects work or sleep. Seek prompt help if pain rapidly worsens, redness spreads, pus appears or fever develops, as broken skin can become infected.