Acquired palmoplantar keratoderma

　　The cause of acquired palmoplantar keratoderma according to traditional Chinese medicine is to seek the cause through clinical diagnosis, and the disease is caused by postnatal disharmony.

　　1. Deficiency of constitution, liver and kidney deficiency, insufficient Yin essence, leading to insufficient liver blood, and unable to nourish the skin and muscles, causing the onset of the disease.

　　2. Deficiency of constitution, Yang deficiency of spleen and kidney, weak warming, insufficient vital Qi and blood generation, and the inability of Qi and blood to reach the four extremities, resulting in the loss of nourishment of the skin and muscles and the formation of disease.

　　3. Deficiency of spleen and stomach Qi and blood, causing insufficient nutrition of营 and blood, and the skin and muscles lose nourishment.

　　4. Emotional discomfort, liver depression transforming into fire, consumes Yin and blood, and the deficiency of blood cannot nourish the skin and muscles.

　　Western medicine believes that acquired palmoplantar keratoderma is related to endocrine disorders, and the progression of digital acrokeratoderma patients is mostly related to the use of soap for washing. There is also evidence that it is related to pregnancy, and the hormone levels in most female patients' blood are significantly low, and the microcirculation examination of most patients shows microcirculatory disorders, but the direct cause of the disease is not yet clear. Climacteric skin keratoderma is related to endocrine disorders, and there are reports that a cholesterol synthesis inhibitor can produce a palmoplantar keratoderma thickening phenomenon similar to this disease, but the exact pathogenic cause still needs further study.

　　Acquired keratoderma plantareum has many complications, and there are many types of keratoderma plantareum. Generally, destructive keratoderma plantareum is often accompanied by congenital ichthyosis, epidermal desquamative hyperkeratosis, cicatricial alopecia, high-frequency hearing loss, hearing loss, perioral seborrheic scales, dark red keratotic plaques, and other diseases. The damaged areas of the patients may have symptoms such as yellow skin and keratosis.

　　Different types of acquired keratoderma plantareum have different symptoms.

　　1. Diffuse keratoderma plantareum:It is an autosomal dominant genetic disease that often occurs in infancy, but may also be delayed until childhood. The initial lesions are focal, and it takes 6 months to 1 year before diffuse damage appears on the palms and soles, with clear borders, hard keratotic plaques, yellowish, waxy appearance, and often with pale red edges. The palms and soles can be affected alone or simultaneously, and the lesions generally do not spread to the dorsal aspects of the hands and feet. It may be accompanied by palmoplantar hyperhidrosis and cloudy nail plates.

　　2. Macular keratoderma plantareum:It is a dominant chromosomal genetic disease that can occur at any age, but is more common during adolescence. The clinical characteristics of this disease are characterized by scattered keratotic papules on the palms and soles. The skin lesions are mostly round or oval, yellow, with hard keratotic papules with a diameter of 2-10mm, scattered or grouped into plaques and linear patterns. A few patients may involve the dorsal aspects of the hands and feet and the elbows and knees. After the keratotic papules fall off, volcanic crater-like small depressions may appear, and the patients do not have palmoplantar hyperhidrosis.

　　3. Epidermal desquamative keratoderma plantareum:The histological picture of the epidermal desquamative keratoderma plantareum is the same as that of the epidermal desquamative hyperkeratotic ichthyosis.

　　4. Punctate (papular) keratoderma plantareum:When keratoderma plantareum is present, dense dyskeratotic columns can be seen in the stratum corneum, the stratum germinativum below the hyperkeratotic area is cup-shaped concave, and there is no inflammation in the dermis.

　　5. Meld type keratoderma plantareum:It often accompanied by palmoplantar hyperhidrosis, nail plate thickening, and other parts showing psoriasis-like damage.

　　6. Papillon-Lefevre syndrome:It often accompanied by palmoplantar hyperhidrosis and periodontal disease.

　　Acquired keratoderma plantareum may be caused by skin irritation and friction, and the preventive measures are as follows:

　　1. Pay attention to diet. Eat more vegetables and fruits, and avoid spicy and刺激性 food. The vitamins in vegetables and fruits are very beneficial to the skin, ensuring the supply of skin nutrition. Spicy and irritating food can cause or worsen the disease, so it is best not to eat or eat as little as possible spicy seafood and other foods. In addition, it is also important not to smoke or drink, and to control one's urge to smoke and eat is the key to prevention.

　　2. Maintain a pleasant mood and strengthen physical exercise. Imbalance of mentality, the appearance of anxiety, irritability, and depression is also a major factor in keratoderma plantareum, so it is necessary to adjust one's mindset at any time in life, release stress appropriately, and talk more with friends. The purpose of strengthening exercise is to enhance immunity, improve the function of the body and skin, and resist external stimulation.

　　3. Avoid external stimulation. The first thing to do is to avoid trauma, reduce the stimulation and friction on the skin, and avoid using soaps and other alkaline cleaning agents. Also, avoid irritant substances such as mineral oils.

　　Acquired palmoplantar keratoderma can generally be diagnosed clearly based on the history of onset, family history, and characteristics of clinical manifestations, but it should be distinguished from congenital palmoplantar keratoderma or symptomatic palmoplantar keratoderma. Acquired palmoplantar keratoderma is a type of acquired keratoderma, with onset mostly in adulthood, without obvious familial susceptibility and heritability. Most patients are systemic diseases or reactions to drugs, such as malignant tumors, immune diseases, endocrine diseases, acanthosis nigricans, etc. Symptomatic palmoplantar keratoderma includes keratotic tinea manuum, chronic eczema of the palmoplantar region, non-hereditary palmoplantar keratosis, etc.

　　This disease has not been clearly recorded in the literature of traditional Chinese medicine, and some types are similar to 'Thick Skin Sore' in traditional Chinese medicine.

　　1. Eat more vegetables and fruits, avoid spicy and irritant foods.

　　2. Maintain a pleasant mood and strengthen physical exercise.

　　3. Try to avoid trauma, avoid contact with soaps, alkalis, mineral oils, and other irritant substances.

　　Acquired palmoplantar keratoderma is a difficult-to-treat disease, mainly characterized by hyperkeratosis, dryness, and fissuring of the skin on the hands and feet. Topically, preparations such as benzoic acid, retinoic acid, and salicylic acid can be used to soften the keratin. Oral retinoic acid is also effective, but liver and kidney function should be monitored.

　　There is no special treatment for acquired palmoplantar keratoderma, and it should be avoided to have trauma. Topically, 0.1% vitamin A acid ointment, 5% to 10% salicylic acid ointment, or 15% to 20% urea ointment can be applied to alleviate symptoms. Vitamin A can also be taken orally. Radiotherapy may be temporarily effective but not lasting.

　　In addition, there are no special requirements for hand washing with palmoplantar keratoderma, but it should be avoided to use soap. Treatment can include oral Avage capsules, vitamin E, and topical application of 0.1% retinoic acid cream.