Clinical Study on Palmoplantar Keratoderma

INTRODUCTION : Palmoplantar keratodermas are a heterogenous group of disorders characterized by hyperkeratosis of palms and soles. They may be inherited or acquired disorders. Clinically there are three major patterns of involvement, diffuse, focal and punctate types. The differentiation between the different types depends on the presence or absence of transgrediens, erythematous borders, hyperhidrosis and systemic involvement. Acquired PPK occur later in life, and attributable to an underlying etiology like inflammatory and reactive dermatoses, infections, drugs, systemic diseases and internal malignancy. In the evaluation of PPK, a thorough history taking including the family history is essential to establish clinical diagnosis to assess the prognosis, to take therapeutic decisions and offer genetic counseling. The terminology and nosology of inherited PPK are continuously evolving. Advances in molecular genetics may help in further simplification. As they are rare disorders, literature reports are based on individual family reports. Only few studies are available about the prevalence of palmoplantar keratoderma in the Indian population. Systematic analysis on the etiology of PPK’s has not been done so far in our population. Hence we have undertaken this study to analyze about PPK in detail. AIM OF STUDY : 1. To study the prevalence of PPK among patients attending the Dermatology OPD, Rajiv Gandhi Government General Hospital, Chennai. 2. To study the etiology of PPK whether inherited or acquired. 3. To analyse the age distribution. 4. To Analyse the sex distribution. 5. To analyse various clinical presentations and associated Symptoms. MATERIALS AND METHODS : STUDY DESIGN : Descriptive study. STUDY PERIOD : Two years from October 2009-September 2011. STUDY CENTRE : Department of Dermatology and Leprosy, Rajiv Gandhi Government General hospital, Madras Medical College, Chennai. STUDY POPULATION : Patients with Palmoplantar keratoderma attending the Out Patient Department of Dermatology and leprosy, Rajiv Gandhi Government General hospital were enrolled for the study. DATA COLLECTION : Based on the proforma, detailed analysis was done which include the history taking, with particular emphasis on the age of onset of the disease, progression of the disease, involvement beyond the palms and soles, discoloration of the keratotic surface, recurrent skin infections, recurrent blisters, constricting bands over digits, auto amputation of digits, dryness of skin, seasonal variation and collodion baby. History of itching, scaling of the skin, characteristics of scales, pain, fissuring of the keratotic surface, bleeding from the fissures, malodor from the thickened surface, burning sensation, skin lesions elsewhere in the body, pigmentary disturbances and photosensitivity was noted History of appendageal involvement like hypo or hyperhidrosis, hair changes like woolly hair, teeth involvement, mucosal involvement and nail changes was also recorded. History of involvement of other structures like eyes and ears and involvement of other systems like cardiovascular system, central nervous system was also enquired. P r evious treatment history and response to the treatment were also recorded.Detailed family history, history of consanguinity and involvement of siblings and first degree relatives were noted. Pedigree chart was drawn for patients with hereditary palmoplantar keratoderma. RESULTS : Out of 86,429 patients who attended our outpatient department during the study period, total number of patients with palmoplantar keratoderma was129 corresponding to 0.15%. Based on the age of onset, family history, consanguinity and clinical presentation, the patients were classified into hereditary and acquired PPK, consisting of 70 and 59 patients respectively, represents 0.08% and 0.06% of total PPK. CONCLUSION : The prevalence of PPK at the Department of Dermatology and Leprosy, Rajiv Gandhi Government General hospital, Madras Medical College, Chennai was 0.15%. Hereditary PPK constituted about 0.08% and acquired PPK constituted 0.06%. In hereditary PPK itself, PPK syndromes and PPK associated with genodermatosis constituted about 61.43% and 38.57% respectively. • Hereditary PPK was commonly detected in second decade (37.14%). Acquired PPK was commonly seen in the fifth decade (33.89%). Overall it was commonly seen in the second decade 32.8%. • Gender wise analysis showed that Hereditary PPK was more common in males (54.29%) than females (45.73%). In hereditary PPK a males topped the list with 61.42%. However in acquired PPK female preponderance is seen with 54.23%. • Acquired PPK was commonly noted in house wives and manual laborers (33.89%). • Diffuse nontransgrediens type was the common pattern (77%) in hereditary type. Focal type was the common pattern (54.27%) in the acquired type. • Unna Thost syndrome was the common one. Among which males were commonly affected. • Others syndromes which was seen in decreasing order of their prevalence were Mal de Meleda, Naxos disease, Griethers disease, Olmsted syndrome, Papillon Lefevere syndrome, Clouston syndrome, Focal plantar keratoderma and Marginal keratoderma. • Among the PPK associated with other genodermatosis, Ichthyosis Vulgaris was frequently seen followed by Bullous Icthyosiform Erythroderma, Lamellar ichthyosis, Sjogren Larsson syndrome, Familial pitryasis rubra pilaris, Kindler syndrome, Epidermolysis bullosa, Symmetrical progressive erythrokeratoderma, Pachy dermo periosteitis and Dowling Degos disease. • In the acquired PPK, psoriasis was the common cause followed by hand and foot eczema. • Psoriasis was common in females and in fifth decade. • Hereditary PPK had poor DLQI SCORE. • The common complications was fissuring. Pitted keratolysis is the common secondary infection. • Systemic associations were found to be rare

Seborrheic keratosis over genitalia masquerading as Buschke Lowenstein tumor

Seborrheic keratosis (SK) is a common benign condition of the skin. It does not usually appear before middle age. Upper trunk and face are the sites most commonly involved. Lesions are also frequently seen on the extremities. SK of the genitalia is a rare entity. It has been frequently mistaken as genital warts and differentiation is made only on histopathology. We report a case of SK with polypoidal lesions restricted to the skin on and around the genitalia since 10 years. SK should be considered in the differential diagnosis of pedunculated lesions of the penis. The histopathology after shave excision is diagnostic