Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
Case Report
2002:68:4;242-242
PMID: 17656955

Palmoplantar keratoderma in myxedema

RR Mittal, Anju Jha
 Department of Dermatology and Venereology, Govt. Medical College and Rajindra Hospital Patiala - 147 001, Punjab, India

Correspondence Address:
R R Mittal
#97, New Lal Bagh, Patiala - 147 001, Punjab
India
How to cite this article:
Mittal R R, Jha A. Palmoplantar keratoderma in myxedema. Indian J Dermatol Venereol Leprol 2002;68:242
Copyright: (C)2002 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

A 45-years-old woman came with diffuse yellowwaxy thickening, dryness and scaly skin of palms and soles and thickening of knuckles on dorsa of hands since 2 years. In addition, she had hoarseness of voice, weight gain, slow response, intolerance to cold, loss of pubic and axillary hair, generalised dryness and coarseness of skin, and mask like fades. Diagnosis of palmoplantar keratoderma and myxedema was confirmed by investigations.
Keywords: Myxedema, Palmoplantar keratoderma (PPK)

Introduction

Palmoplantar keratoderma (PPK) is a multjetiological disorder which is subclassified into two main types that is hereditary- congenital and acquired.[1] Acquired PPK may be associated with neurodermatitis, psoriasis, lichen planus, tineasis, Reiter′s syndrome, pityriasis rubra pilarjs, verrucae, fungal infections, keratoderma climactericum, contact dermatitis and syphilis.[2] PPK in association with myxedema was first reported 1952.[3] Myxedema associated with severe palmar keratodema was reported later in 1977[4] followed by another case report in 1986.[5] Increased propensity to overkeratinisation could be responsible for PPK. Striking improvement in long standing PPK with thyroid hormones, further supported that causal relationship was possible between PPK and myxedema.[5]

Case Report

A 45-year-old woman came with the complaint of non pruritic diffuse thickening of plams and soles for the past 2 years. The patient gave history of weight gain, hoarseness of voice, stiffness of joints, difficulty in extension of hand, intolerance to cold and was in menopause for past 1 year. The patient was alert though her responses were slow. There was generalized coarseness, dryness of skin and loss of pubic and axillary hair. The palms and soles showed diffuse yellow, waxy, hyperkeratotic skin. The dorsa of the hands also showed thickening which was more prominent on the knuckles.

The endocrine function tests showed: serum T3-0.92ng/ml (normal: 0.8-1.8), T46.7mcg/dl (normal: 5-11.5) and TSH-4.2 µu/ml (normal: 0.25-3.8), thus confirming the diagnosis of myxedema. Cholesterol level was 180 mg%. Skin biopsy was taken from the sole and showed the following: marked hyperkeratosis, hypergranulosis and acanthosis.

The patient was put on thyroid hormone (eltroxin 150mgOD) and topical, keratolytics and steroids, Steady improvement occurred in the form of disappearance of stiffness of fingers, decrease in thickness, dryness of skin and disappearance of scales, during 8 months therapy and followup.

Discussion

The present case could be of PPK due to associated myxedema or a case of PPK climactericum. PPK climactericum was excluded as involvement was diffuse and histopathology showed no feature of spongiosis with exocytosis.[6] She had taken treatment from other sources but improvement this time was far better after topical therapy along with thyroid hormone. This also favoured the fact that PPK was due to myxedema. We do agree with the opinion of Hodak et al that although rare, myxedema could be a cause of PPK due to its propensity for overkeratinisation and addition of thyroid hormone therapy helps in treating PPK.

References
1.
Itin PH, Lautenschlager S. Palmoplantar keratoderma and associated syndromes. Seminars in Dermatology 1995;14:152-161.
[Google Scholar]
2.
Zemtsov A, Veitschegger M. Keratodermas. Int J Dermatol 1993;32:493-498.
[Google Scholar]
3.
Shaw WM, Mason EH, Kalz EG. Hypothyroidism, liver damage and vitamin A deficiency as factors in hyperkeratosis. Arch Dermatol Syph 1952;66:197-203.
[Google Scholar]
4.
Tan OT, Sarkany I. Severe palmar keratoderma in myxedemo. Clin Exp Dermatol 1997;2:287-288.
[Google Scholar]
5.
Hodak E, David M, Feuerman EJ. Palmoplantar keratoderma in association with myxedema. Acta Derm Venereal (Stockh) 1986;66:354-357.
[Google Scholar]
6.
Deschamps P, Leroy D, Pedailles S, et al. Keratoderma climoctericum (Haxthauser s disease): Clinical signs, laboratory findings and etretinate treatment in 10 patients. Dermatologica 1986;172:258-262.
[Google Scholar]
Show Sections