Hyperkeratosis

Hyperkeratosis of the Elbow

Hyperkeratosis is a thickening of the skin that occurs in women with brown skin. It is due to excessive accumulation of keratin in the outer layers of the skin. Thickening of the skin protects it against rubbing, pressure and irritation. The majority of the forms of hyperkeratosis are painless. Although hyperkeratosis may occur anywhere on the skin, there are several areas that are typically involved.

  • Elbows and knees are common sites for thickening of the skin. Hyperpigmentation accompanies this type of hyperkeratosis which is due to repeated leaning on the elbows and kneeling on the knees.
  • The palms and the soles, especially the heels, are areas that frequently become thickened. This form of hyperkeratosis may develop from ill-fitting shoes, walking barefoot or from other forms of friction. On the hands, calluses may develop and on the feet, corns.
  • Keratosis pilaris is a form of hyperkeratosis involving the back of the arms, the front of the thighs and inside the knees. With this form of hyperkeratosis small rough bumps appear around the follicles. Contrary to common belief, this condition is not caused by dirt. Although a cause has not been identified, keratosis pilaris is sometimes seen in association with ichthyosis vulgaris (see below) and less commonly with atopic dermatitis (eczema).
  • Ichthyosis is an inherited form of hyperkeratosis in which there is dry and scaly skin that resembles the scales of a fish. There are several different types of ichthyosis and the most common type is ichthyosis vulgaris.

Your doctor will be able to diagnose hyperkeratosis by examining your skin and then he or she will decide the most effective treatment. For some types of hyperkeratosis there is no cure. However, various treatments are available. Prevention is always the best cure and that is the case for hyperkeratosis .

Prevention of hyperkeratosis

  • Elbows and knees
    • Avoid leaning on elbows and knees
    • Kneel on a cushioned pad if necessary
    • Do not rub, scrub or manipulate the areas
  • Soles, corns and calluses
    • Wear low heal shoes so that your weight is distributed evenly on your sole
    • Avoid shoes that are tight around your toes or sides of the feet
    • Apply moleskin or other padding to areas of the feet that are being rubbed
    • Avoid going barefoot
    • Do not scrub or rub your soles

Treatment
Treatment of hyperkeratosis depends on the type, location, severity and cause. Most treatments are aimed at softening the keratin and removing the thickened skin. This may be accomplished with topical creams that contain as the active ingredient salicylic acid, alpha-hydroxy acid (lactic or glycolic acid), urea, or tretinoin. In brown skin, discoloration often accompanies the hyperkeratosis and skin lightening creams may also be used.

Salicylic acid, which is one of the more commonly used medications for hyperkeratosis, is a keratolytic agent which means that it breaks up or lyses the keratin, It also enhances shedding of the thickened skin and softens it. One prescription formulation of salicylic acid, Salex Cream or Lotion, is time-released as opposed to being spike-released, reduces water loss from the skin and increase skin hydration.

Topical urea creams and lotions treat hyperkeratosis by increasing water content in the skin thus softening it. Urea also breaks up or lyses components of the keratin. The alpha-hydroxy acids, lactic and glycolic acid, exfoliate the thickened layers of keratin and also add moisture to the skin. Finally, tretinoin is useful in the treatment of hyperkeratosis by increases the shedding of the thickened skin.

Bottom Line

Hyperkeratosis can be an embarrassing problem for women with brown skin. Thickened, rough palms and soles as well as darkened elbows and knees, and rough bumps on the arms and legs, respond to creams and lotions that both removed the thickened skin and soften it. Scrubbing and rubbing these areas, which is often your natural inclination, will simply make the problem worse.

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