Hyperkeratosis

What is hyperkeratosis?

Hyperkeratosis is a condition that causes your skin to thicken in certain places. The thickening occurs when your body produces too much keratin, a protein found in your skin’s outer layer. Hyperkeratosis also can affect any area of your body, including your hands, feet, mouth, nose and nails.

Anyone can get hyperkeratosis. Some people have it at birth. Other people develop this condition as children or adults.

There are two main types of hyperkeratosis:

• Non-pressure-related hyperkeratosis: Thickening of your skin due to genetics.
• Pressure-related hyperkeratosis: Thickening of your skin due to inflammation, irritation or pressure.

Various forms of hyperkeratosis include:

• Actinic keratosis: Reddish, scaly precancerous growths caused by sun exposure.
• Corns and calluses: Thick layers of hard skin.
• Eczema: Dry, scaly patches on your skin.
• Epidermolytic hyperkeratosis: Thickened skin patches on your hands, feet (plantar hyperkeratosis) or elsewhere that are present at birth.
• Keratosis pilaris (follicular hyperkeratosis): Tiny bumps usually found on your upper arms.
• Lichen planus: Bumps on your arms and legs or inside your mouth.
• Psoriasis: Silvery scales on your skin.
• Retention hyperkeratosis: Skin cells that don’t shed properly from your skin’s surface, causing acne.
• Seborrheic keratosis: Noncancerous black or brown patches on your back, face, neck or shoulders.
• Subungual hyperkeratosis (hyperkeratosis of the nail): A chalky substance underneath your nails.
• Warts: Small bumps on your skin, including plantar warts on the soles of your feet.

What is hyperkeratosis caused by?

Several factors may cause hyperkeratosis, including:

• Allergies.
• Autoimmune diseases.
• Chronic inflammation of the skin (dermatitis).
• Infections of the skin, including HPV (human papillomavirus).
• Genetics.
• Medications, including chemotherapy.
• Pressure or rubbing of your skin.
• Psoriatic arthritis.
• Reactions to chemicals, including tattoo ink.
• Skin infections.
• Sun exposure.
• Vitamin A deficiency.

What are the symptoms of hyperkeratosis?

The main symptom of hyperkeratosis is rough patches of skin from excess keratin. Other symptoms are specific to the types of hyperkeratosis.

Hyperkeratosis usually doesn’t cause pain, except for:

• Calluses.
• Corns.
• Plantar warts.

What does hyperkeratosis look like?

Hyperkeratosis can look different for each person, depending on the type and location. But there’s one thing all cases have in common — an area of rough skin that feels different from the surrounding tissue.

If you think you might have hyperkeratosis, talk to a healthcare provider. They can give you a diagnosis and recommend appropriate treatment.

How is hyperkeratosis diagnosed?

Your healthcare provider will ask about your:

• Family history of skin conditions.
• History of sun exposure.
• Medical history, including allergies, autoimmune diseases and skin issues.
• Medications you take.
• Symptoms.

Your provider will do a physical examination and take a close look at your skin. They may examine your skin with a handheld device that gives off light (dermatoscope). Your provider will specifically look for signs of scaling of your skin. 

If they suspect hyperkeratosis, they may do a skin biopsy. Your provider may also suggest allergy testing to help determine the underlying cause. 

How do you get rid of hyperkeratosis?

Treatment depends on the type of hyperkeratosis you have.

Your healthcare provider may prescribe medications like:

• Corticosteroids for eczema, lichen planus and subungual hyperkeratosis. 
• Medicated creams for actinic keratosis, psoriasis and subungual hyperkeratosis.
• Oral medications for epidermolytic hyperkeratosis, keratosis pilaris and psoriasis.

They may prescribe treatments that include:

• Chemical peels for actinic keratosis.
• Exfoliation for keratosis pilaris and retention hyperkeratosis.
• Filing down of skin for calluses and corns.
• Freezing (cryotherapy) for actinic keratosis, seborrheic keratosis and warts. 
• Laser treatments for keratosis pilaris and warts.
• LED light therapy for actinic keratosis, eczema and psoriasis.
• Shave removal technique for seborrheic keratosis and warts.

Keratosis pilaris may stop on its own, without treatment. There’s no cure for epidermolytic hyperkeratosis, though medications can help treat symptoms.

How soon after treatment will I see results?

Results will depend on the type of hyperkeratosis you have, the severity of your condition and the treatment you use. You may see results immediately or it could take several months.

Your provider will monitor your progress during follow-up visits. That way, if one treatment isn’t working, they can suggest other options.

How can I reduce my risk of hyperkeratosis?

You can reduce your risk of some forms of hyperkeratosis:

• Actinic keratosis: Avoid sun damage by limiting sun exposure, wearing broadband sunscreen with at least SPF 30 and dressing in protective clothing. 
• Corns and calluses: Wear comfortable shoes. 
• Eczema: Reduce environmental triggers, like dry air, extreme cold or hot temperatures, perfumed soaps and strong chemicals.
• Skin inflammation: Limit your exposure to allergy triggers, like pets or pollen. 
• Warts: Don’t go barefoot in public areas like gyms, locker rooms or pools. 

You can’t reduce your risk of epidermolytic hyperkeratosis because it’s an inherited form of hyperkeratosis.

What can I expect if I have hyperkeratosis?

You can manage most forms of hyperkeratosis with proper treatment. Without treatment, hyperkeratosis may worsen over time. For instance, actinic keratosis may develop into squamous cell carcinoma without proper monitoring and treatment.

How do I take care of myself with hyperkeratosis?

Hyperkeratosis can affect your sense of well-being, especially if you have visible scaly patches on your face, neck or scalp. Talking to your provider or a therapist about your concerns can help.

Here are some other things you can do to take care of yourself:

• Avoid home remedies for hyperkeratosis unless you discuss them with your provider first.
• Drink plenty of water to stay hydrated.
• Don’t touch any scaly patches, except to apply medication.
• Practice good hygiene, including keeping your skin clean and preventing dryness.
• Don’t take hot baths.
• Use soap-free cleansers or mild soaps.

When should I see my healthcare provider?

See your provider if you notice any other skin changes during treatment, like:

• Pain.
• Pus.
• Redness.
• Swelling.

You should let your provider know if you have concerns about side effects, or if you don’t notice results. They’ll be able to suggest other treatments that may help.

Should hyperkeratosis be removed?

It depends on location and severity. Healthcare providers can remove certain types of hyperkeratosis (like warts or calluses). Other types (like lichen planus or keratosis pilaris) may require medication, ointments or other treatments.