Thickening of the skin, or hyperkeratosis - causes of appearance, what diseases it occurs with, diagnosis and treatment methods

Skin xerosis is an abnormal dryness of the upper layer of the skin caused by changes in the hydrolipid balance of the skin. It manifests itself as a dry, rough structure of the surface of the skin. The skin becomes cracked, inflamed, and infected. With the disease, the entire spectrum of pathological skin changes is observed: disturbances in sebum secretion, sweating, skin lipids, amino acid deficiency, and a feeling of discomfort. The condition is constantly accompanied by itching, which reduces the patient’s quality of life.

Causes

The main mechanisms for the development of dryness and flaking of the skin are a violation of its acid-base balance, poor functioning of the sebaceous glands, too frequent renewal of the upper layer of the epidermis and moisture deficiency in the epithelium.

The reasons may be: external influences, various diseases - both dermatological and general, and the general condition of the body. Of the external factors that have an adverse effect on the skin and cause dry skin, the most significant are the following:

exposure to aggressive substances;
chapping, hypothermia or overheating of the skin (for example, a sauna);
improper skin care;
exposure to ultraviolet radiation, especially in combination with weathering, or prolonged contact with an alkaline environment (for example, staying on the beach by the sea);
regular exposure to hot or extremely cold water, especially chlorinated water.

Dry and flaky skin can be symptoms of the following diseases: allergic reaction; acquired, hereditary or congenital skin diseases, including psoriasis, seborrhea, eczema, atopic dermatitis, ichthyosis; diseases of bacterial, viral, inflammatory, hereditary and other etiologies. Dry and flaky skin may indicate the presence of: endocrine diseases (hyper- or hypofunction of the thyroid gland or adrenal glands, diabetes mellitus); problems with the digestive tract (gastritis, duodenitis, cholecystitis); metabolic disorders; some neurological ailments (migraine, autonomic-vascular dysfunction, neuralgia, neuroses, depression); damage to the endocrine system and other diseases requiring treatment. The most common cause of the development of xerosis is poor nutrition and, as a result, a lack of minerals and vitamins in the body. Spring peeling of the skin, often mistaken for an allergy, is in fact most often a manifestation of a lack of vitamins in the body. It is dull, dry and flaky skin that in most cases is the first symptom of vitamin deficiency A, E, B1 and C. Interestingly, a deficiency of vitamin B6 manifests itself on the contrary, with oily skin prone to acne formation. Dry hand skin may indicate a lack of vitamins A, E, B7 and D. Dry and flaky skin can also be caused by a lack of minerals (zinc, magnesium) and Omega 3 (polyunsaturated fatty acids).

Skin xerosis. Solving the problem externally

Xerosis is caused by impaired sebum and sweating, a deficiency of amino acids contained in the stratum corneum of the skin, and dehydration. Most often, xerosis appears on the skin of the feet due to an initially small number of sebaceous glands, slow turnover of epithelial cells and a pronounced violation of the protective functions of the skin.

The main cause of dryness is a lack of moisture in the stratum corneum of the skin; with a long-term process, peeling, a feeling of tightness, irritation, microcracks and itching appear.

Dryness occurs due to insufficient care, poor circulation, which is facilitated by constitutional features, wearing tight clothes and tights, tight shoes, insufficient moisture intake, and also due to alkalization of the skin with hygiene products and the use of harsh abrasive products. The problem with dryness most often manifests itself in the autumn-winter period due to the fact that with the onset of cold weather, the feet are constantly in contact with warmer and coarser woolen fabrics and synthetics, and this prevents sufficient air penetration; In addition, seasonal vitamin deficiency affects it. At the same time, problems can also arise in the summer, which is associated with prolonged exposure to the sun and walking barefoot. With proper and regular care, an aesthetically pleasing appearance is achieved. The main causes of skin xerosis and options for their correction are presented in Table 1.

The main pathogenetic mechanisms of increased skin dryness are:

1) a decrease in barrier function due to the failure of the lipids of the stratum corneum, a violation of their structure and location, which causes defects in the intercellular lipid layers, which leads to an increase in transepidermal moisture loss;

2) a decrease in the ability to retain moisture due to a lack of hygroscopic substances inside corneocytes, the so-called natural moisturizing factor (NMF), which consists of free amino acids and their derivatives, lactic acid, urea and other components that create the hydrolipid mantle of the skin [5];

3) disruption of moisture transport from the dermis to the epidermis and stratum corneum.

All this leads to dehydration of the epidermis and the development of a clinical picture of xerosis [1–3].

The group of chronic dermatoses, accompanied by dryness, hyperkeratosis and peeling, includes a large number of skin diseases. These include such common diseases as psoriasis, eczema, atopic dermatitis with lichenification, squamous-hyperkeratotic forms of mycoses, and rare nosological forms - ichthyosis, keratoderma, etc. Xerosis is also characteristic of age-related changes or can be caused by concomitant somatic pathologies - diseases thyroid gland, diabetes mellitus (DM), vitamin deficiency, metabolic disorders.

The process of development of dehydration at the cellular level is presented in Figure 1, and the stages of clinical manifestations during the development of skin xerosis with possible correction methods are shown in Figure 2. It should be noted that these phases can be traced for all manifestations of dry skin, both in chronic dermatoses and for somatic diseases.

Xerosis of the skin of the feet in diabetes is one of the provoking factors of diabetic foot syndrome. Statistics show that the appearance of diabetic foot signs is associated with the stage of decompensation in individuals suffering from type 2 diabetes; manifests itself in 90% of patients [4]. This condition occurs due to angio- and neuropathy of the feet, i.e. destruction of nerves and blood vessels, while tissue nutrition deteriorates, their protective function decreases, and this leads to trophic changes and thereby increases the risk of developing gangrene or ulcers even with minimal injuries. Such patients complain of discomfort in the legs, stabbing and burning pain when the legs are at rest, at night, as well as severe pain when walking. Over time, the sensitivity of the feet noticeably decreases, the color of the skin of the lower extremities changes - it becomes pale or with a slight brownish pigmentation, at the same time dryness, peeling of the skin, cracks, microvesicles with serous contents, as well as thickening of the stratum corneum of the skin of the feet appear. All this shows that xerosis of the skin in diabetes, both due to general dehydration and autonomic diabetic neuropathy with impaired innervation and regulation of the sweat glands, is not only a cosmetic problem, but also one of the links in the development of diabetic foot syndrome.

Dry skin to one degree or another occurs in 85% of patients at the appointment. Therefore, practicing doctors encounter such patients every day, sometimes they make up the majority of adult dermatological appointments. Advances in pharmacology, in particular combined anti-inflammatory drugs with exfoliating components, have significantly improved the quality of life of patients, and their availability and variety in pharmacy chains make it possible to make choices and experiment with treatment methods. Over time, new issues have arisen in the treatment of dermatoses accompanied by hyperkeratoses, namely, the duration of use of combined and monosteroids, anti-relapse and preventive therapy, care for hyperkeratotic conditions and peeling, the correction of which is initially difficult due to genetic “breakage” or due to concomitant diseases.

Currently, there is a reassessment of the importance of cosmeceuticals in the therapy and care of the skin of patients with xerosis, chronic dermatoses, and diabetes. There are a number of modern lines of medical cosmetics for skin care for hyperkeratosis, which have proven themselves, are widely available for everyday use and often have a pronounced softening, exfoliating and moisturizing effect. Basic drugs, most often based on topical steroids, have high expectations in terms of their antiproliferative, resolving, antipruritic, anti-inflammatory, antibacterial and healing effects. But such properties, while maintaining a softening, moisturizing and exfoliating effect, are also inherent in classic dermatropic components with metabolic, hydrating and softening effects: urea, various acids, panthenol, complexes of oils, alkaloids and flavonoids.

To successfully combat dry feet, you first need to find out the cause of its occurrence. Diagnosis of dry skin involves excluding fungal infections, various endocrinopathies, skin diseases, and identifying the causes of xerosis. If the cause is any disease, then it is necessary to first cure it or correct the condition, and then deal with the manifestations. In some cases, with a severe inflammatory reaction, the prescription of glucocorticosteroid or combination creams with the parallel use of care products is required. But sometimes the use of moisturizers, which have pronounced effectiveness in treating dryness of various origins, high organoleptic properties, a high safety profile and good tolerability, leads to the desired result. At the same time, it has been clinically proven that anti-inflammatory drugs in combination with emollients are more effective than monotherapy with glucocorticosteroids. Thus, one of the main tasks when the skin barrier function is impaired is protection and hydration. Examples of products that effectively solve these problems are foot balms Balzamed and Balzamed intensive (Esparma GmbH, Germany), which are recommended for daily care of dry and sensitive skin of the feet, prone to redness, irritation, the formation of chafing and calluses, especially in patients with diabetes. .

Balzamed balms provide the skin of the feet with sufficient hydration and nutrition, preventing the formation of chafing and calluses, the appearance of peeling, redness and irritation on the skin of the feet. Balzamed balms contain a balanced composition of vital vitamins, moisturizing components and softening vegetable oils.

Balzamed and Balzamed intensive balms contain the following components:

Vitamin A, which protects against excessive keratinization and increases the skin's resistance to infections, protects it from the formation of microcracks, slows down the aging process, improves its elasticity and general condition.

Vitamin E (tocopherol acetate) is an antioxidant, binds free radicals, protects skin cells from metabolic damage caused by metabolic disorders, as well as from external environmental influences, helps reduce skin itching.

Vitamin F increases skin elasticity, regulates moisture content, and promotes rapid healing of microcracks.

Provitamin B5 (panthenol) accelerates the healing of small wounds, maintains water balance and skin resistance to external environmental influences, stimulates the regeneration of skin and mucous membranes, normalizes cellular metabolism, accelerates mitosis and increases the strength of collagen fibers, has a regenerating and anti-inflammatory effect.

Lactic acid promotes exfoliation and hydration, faster cell renewal.

Urea increases the absorption of water by keratinized areas of the skin, actively moisturizes dry skin and increases its permeability to vitamins, and also protects against external environmental influences; easily penetrates into the deep layers of the epidermis and serves as a conductor for other active components; has keratolytic, wound healing and bacteriostatic effects.

Avocado and jojoba oils contain vitamins A, B, D, E and K, soften, moisturize and nourish the skin, have a protective effect, restore skin elasticity, and prevent premature aging.

Zinc stearate, which is part of Balzamed intensive, stabilizes the skin of the feet and promotes healing.

Thus, the components included in the balms Balzamed and Balzamed intensive have a pronounced anti-inflammatory, antipruritic, exfoliating and antimicrobial effect, help restore damaged skin, increase the regenerative and barrier functions of the skin, prevent the feeling of dryness and irritation, relieve itching, promote hydration and restoration of affected areas of the epidermis. These drugs can be used both in complex therapy with anti-inflammatory glucocorticosteroid drugs, and independently, as a means of daily skin care.

In order to achieve maximum positive results, it is recommended to apply the foot balm daily to the damp skin of the feet, especially to areas subject to pressure and friction, rubbing in with light massaging movements.

Regular care of the skin of the feet using Balzamed will prevent the appearance of peeling, redness and irritation on the feet, the formation of corns and calluses, give elasticity and firmness to the skin, and prevent premature aging.

Skin xerosis is, as a rule, cyclical in nature with periods of deterioration, especially in the autumn-winter period, and therefore foot balms Balzamed and Balzamed intensive are the main links in both therapeutic and preventive care for the skin of the feet and allow you to completely cope with the problem of dry skin , including with such serious concomitant diseases as diabetes.

Symptoms

Most often, dry skin is a temporary problem that only bothers you during a certain season, but it can last a lifetime. Symptoms of xerosis depend on your general health, age, where you live, and how much time you spend outdoors. Possible symptoms include:

Feeling of tightness of the skin, especially after a bath.
The skin is wrinkled and dehydrated.
The skin looks rough instead of smooth.
The itching is disturbing, sometimes very intense.
Peeling of the skin - from slight to severe.
Cracks in the skin, sometimes bleeding and painful.
Redness of the skin, usually in limited areas.

Treatment of dry skin dermatitis in patients with diabetes mellitus

Timely detection and treatment of skin xerosis in patients with diabetes is necessary to prevent the development and progression of a number of complications, in particular diabetic foot syndrome. The main method of eliminating dry skin in this category of patients is the use of external products with urea and vitamins, such as Balzamed and Balzamed intensive. The products in this series have been highly appreciated by both doctors and patients.

Introduction

Diabetes mellitus (DM) has remained a significant medical and social problem for many years. It is one of the most important causes of disability and mortality. In addition, its high prevalence is noted. Thus, according to the International Diabetes Federation (IDF), in 2021 there were 425 million people with diabetes in the world, and by 2030 their number could reach 600 million [1]. An increase in incidence is also observed in our country. The incidence of diabetes has more than doubled over the past 15 years and currently accounts for 2–5% of the population. According to the state register of patients with diabetes, as of December 31, 2016, there were 4.35 million patients, 4 million (92%) were diagnosed with type 2 diabetes. However, according to experts, the real number of patients is much higher. According to the results of epidemiological studies, not all people suffering from diabetes are registered; a significant proportion of people with metabolic syndrome and impaired carbohydrate tolerance are at high risk of developing pathology in the near future [2].

The pathogenesis of diabetes is complex and multifactorial. Insulin resistance, dysfunction of pancreatic beta cells, heredity, physical inactivity, and poor nutrition cause various metabolic changes. However, oxidative stress plays one of the leading roles in the development of diabetes. The body's antioxidant system is not able to resist this pathological process.

As a result of hyperglycemia, endoneurial blood flow decreases, capillary permeability is impaired, endoneurial vascular resistance increases, and endoneurial oxygen tension decreases. This leads to hypoxia, deterioration of blood supply to nerve fibers, disruption of their function and the development of diabetic neuropathy.

Metabolic changes, oxidative stress, decreased antioxidant protection, micro- and macroangiopathy, neuropathy cause complications that are practically not diagnosed at the preclinical stage, but are treated at the clinical stage, but with certain difficulties.

It is known that the skin is one of the first to react to processes occurring in the body. A change in her condition may be one of the signs of the development of diabetes.

The epidermis consists of several layers of epithelial cells that continuously divide, due to which the skin quickly renews itself. At the same time, dead cells are constantly exfoliated. With changes in the epidermis, the division of epithelial cells and, consequently, skin renewal slows down. In some areas the skin becomes thinner. As a result, its protective functions are reduced and the risk of injury increases. On the skin of the hands and feet, in the area of maximum friction and pressure, the exfoliation process slows down and the stratum corneum thickens. A decrease in the rate of cellular metabolism leads to a deficiency of natural moisturizing factor. The latter consists of free amino acids, urea and other components that create a hydrolipid mantle. In addition, normal skin is 70% water. Changes associated with diabetes cause dehydration. With a long-term pathological process, peeling, a feeling of tightness, dry skin (xerosis), and itching appear.

The dermis contains thin bundles of elastic tissue, collagen, muscle fibers, nerve endings, and blood vessels. With diabetes, the renewal of dermal structures is disrupted, and the skin loses its elasticity. Its turgor, hydration and tone decrease. Due to neuropathy and ischemia, the function of fatty tissue structures - sweat and sebaceous glands - is disrupted. The acidity of the epidermis changes, barrier properties decrease and preconditions are created for the development of infections. The process of thermoregulation is disrupted. Hair loss increases.

Changes in the skin, in particular xerosis, in patients with diabetes are one of the factors in the development of diabetic foot syndrome [3, 4]. It is characterized by a certain stage pattern: microcracks, foot ulcers, gangrene, osteomyelitis. The latter conditions may require hospitalization and limb amputation [3–8]. As noted earlier, treating the clinical stage and complications of diabetic foot syndrome is difficult.

Therapeutic and preventive measures for skin xerosis can avoid or delay the development of diabetic foot syndrome. At the initial stage of xerosis, external agents in the form of creams, balms, and moisturizers are widely used. The results of comparative studies of their effectiveness in patients with diabetes were contradictory. However, most researchers preferred creams with urea (urea). Urea helps to moisturize the skin and remove dead skin particles.

Higher compliance was noted when using products from the Balzamed and Balzamed intensive series due to a fairly rapid anti-inflammatory, moisturizing and regenerating effect [9, 10].

These products contain 10% urea, vitamins A, E, F, avocado and jojoba oils, which improve skin trophism, normalize the healing process, and have a positive effect on microcirculation.

Experience in using Balzamed and Balzamed intensive

We evaluated the effectiveness of Balzamed and Balzamed intensive in the treatment of skin xerosis in patients with diabetes.

A 68-year-old patient consulted a general practitioner with complaints of thirst, general weakness, fatigue, numbness and itching in the feet and legs after a night's sleep and during the day, and a feeling of uncertainty when walking.

From the anamnesis: type 2 diabetes mellitus was diagnosed at the age of 63 after a visit regarding frequent urination. Metformin 850 mg/day and a drug to lower cholesterol levels were prescribed. In addition, a special diet, physical activity, regular monitoring of blood glucose, and periodic visits to the doctor are recommended. The patient regularly took only metformin, did not follow a diet, did not perform self-monitoring of blood glucose, and did not visit a doctor. Arterial hypertension - ten years, regularly took antihypertensive drugs. Blood pressure ranges from 140–150/90–95 mm Hg. Art., measured on demand - once or twice a month for headaches and dizziness. The maximum blood pressure numbers are 180/100 mmHg. Art. The patient smokes (a pack of cigarettes a day) and drinks alcohol (several times a month). Has a family history of arterial hypertension on the paternal side and type 2 diabetes on the maternal side. There is no allergic history.

Physical examination: satisfactory condition. The physique is hypersthenic. Third degree obesity (body mass index > 42 kg/m²). The respiratory rate is 18 per minute. There is a clear pulmonary sound over the entire surface of the lungs. Breathing is vesicular, there are no wheezes. Heart rate – 76 per minute, pulse rhythmic. Heart sounds are rhythmic. Blood pressure in a sitting position – 145/95 mm Hg. Art. Pulsation in the peripheral arteries of the feet is preserved. The abdomen is soft, painless on palpation. Pasternatsky's symptom is negative on both sides. Peripheral lymph nodes are not enlarged. There is no peripheral edema.

Inspection and assessment of the condition of the skin and appearance of the lower extremities: the skin of the lower extremities is pale, dry, rough to the touch, no redness. Elasticity is reduced. The pathological skin process is symmetrical, localized on the soles of the heels and big toes, represented by hyperkeratosis, numerous small scales, emphasized by a skin pattern. No calluses, corns, cracks or ulcerative defects were found. The joints of the feet are not deformed. There is no hair on the lower legs. The nail plates are not changed.

Neurological examination: the patient is oriented in place and time, memory is not impaired in relation to current and distant events, attention is significantly reduced. Emotionally labile, unkempt. Pronounced reflexes of oral automatism. Limb strength is satisfactory. Paresis is not observed. Muscle tone is slightly increased in the limbs according to the plastic type. Muscle atrophy was not detected. Tendon reflexes of moderate vivacity in the hands (S = D), knee reflexes - torpid, Achilles - absent. Instability in the Romberg pose. Intentional tremor and ataxia during coordination tests. Vibration sensitivity is reduced on the big toes of both feet – 4–5 arb. units, on both ankles – 5 conventional units. units Muscle and joint (proprioceptive) sensitivity is preserved. Pain and tactile sensitivity is reduced: hypoesthesia in the distal parts of the lower extremities, like socks. Temperature sensitivity is preserved.

It should be noted that the study of vibration sensitivity was carried out using a graduated tuning fork according to Rüdel - Seiffer, vibration frequency - 128 Hz. The handle of the vibrating instrument was alternately applied to the big toes and ankles. To obtain reliable results, measurements were carried out at least three times. When the patient stopped feeling the vibrations of the tuning fork, the scale readings were noted. Normally, vibration sensitivity should be more than 6 conventional units. units

Proprioceptive sensitivity was determined in the supine position with eyes closed. The patient determined the direction of flexion of the toes - up or down.

Superficial sensitivity was also tested in the supine position with eyes closed. Sensitivity was compared in symmetrical areas in the direction from distal to proximal. To assess pain sensitivity, a disposable toothpick was used; for tactile sensitivity, a piece of cotton wool; for temperature sensitivity, test tubes with warm and cold water were used.

Clinical blood test: normal hemoglobin – 120 g/l.

Biochemical blood test: glucose – 10.2 mmol/l, glycosylated hemoglobin – 10%, cholesterol – 7.8 mmol/l, low-density lipoprotein cholesterol – 4.5 mmol/l, high-density lipoprotein cholesterol – 0.5 mmol/l , triglycerides – 2.3 mmol/l.

General urine test: glucose level is within normal limits, protein level is negative.

Electrocardiogram: sinus rhythm, regular, left ventricular hypertrophy.

Based on the nature of the patient’s complaints, medical history, assessment of the condition of the skin of the feet, results of a neurological examination and laboratory tests, a diagnosis was made: non-insulin-dependent diabetes mellitus of moderate severity with multiple complications (E11.7), diabetic sensory polyneuropathy (G63.2), dry dermatitis skin (L85.8), arterial hypertension of the second degree of the second stage.

Balzamed intensive was prescribed for the treatment of xerosis. Dosage: several times a day and at night for a month or until clinical improvement. The skin must first be cleaned and treated with pumice.

Based on statistics and personal experience, patients with diabetes have low compliance with treatment. To increase this, the possible risk of complications if the patient refuses treatment was discussed, and the prescription of Balzamed intensive was justified. To prevent dry skin, the patient was taught proper foot skin care (foot hygiene), informed about external factors that can increase skin xerosis: dry air, especially indoors in winter, high temperature and ultraviolet radiation, hot baths, use of alkaline detergents, wearing tight shoes and synthetic underwear.

To assess the effectiveness of treatment, the skin of the feet was examined every ten days.

In addition, the patient kept an observation diary.

The positive effect of treatment was noted after ten days. The maximum result is achieved after 30 days. Externally, the skin of the feet looked soft, smooth, moisturized and elastic, the scales disappeared, and the skin pattern smoothed out. In the self-monitoring diary, the patient noted the ease of use of the balm, the pleasant sensations after its application, and its effectiveness.

At the end of treatment, Balzamed was recommended to prevent dry skin. Unlike Balzamed intensive, this product has a lighter texture.

Our results are consistent with the results of a number of studies. In particular, a comparative study of the effectiveness of Balzamed intensive and a drug containing urea was carried out by O.V. Udovichenko and E.V. Bagel [11]. The study involved 45 patients with type 1 and type 2 diabetes who had dry skin on their feet. The average age of patients is 60 ± 12 years, disease duration is 13 ± 7 years. The patients were divided into two groups: the first received Balzamed intensive, the second received a comparison drug. The products were applied twice a day for one month.

The condition of the skin was assessed by examining the heel areas, the severity of skin xerosis was determined using the Exelbert scale. Zero points on this scale means normal skin condition, one point - the presence of mildly defined scales, two points - many scales, three - a small number of polygons, four - a moderate number of polygons, five - a pronounced network of polygons, six - superficial cracks, seven - cracks moderate depth, eight points – deep cracks (bleeding, etc.). When using Balzamed, the intensity of manifestations of xerosis decreased on average by 44%, when using the comparison drug - only by 22%.

In the study of L.S. Kruglova et al. 60 patients with various chronic dermatoses localized on the feet were included. The age of the patients ranged from 12 to 74 years, with an average of 42.6 ± 5.7 years. All study participants were prescribed comprehensive treatment in accordance with medical standards. As a basic therapy, Balzamed intensive is recommended twice a day for one to one and a half months. The Dermatological Symptom Scale Index was used to assess skin condition. With its help, the severity of symptoms such as xerosis, hyperkeratosis, desquamation, cracks, erythema, pain, itching is determined using a three-point system.

After the onset of clinical remission, Balzamed was recommended to all patients. Application regimen: four times a day for six months.

Based on the results of the study, the following conclusion was made: Balzamed intensive and Balzamed are characterized by high therapeutic and preventive effectiveness. They restore the water-lipid barrier and skin functions [10]. According to the research results, as well as our observations, no allergic or other adverse reactions were detected during the use of Balzamed intensive and Balzamed.

Thus, products from the Balzamed series can be recommended to patients with diabetes for the treatment of dry skin dermatitis and regular care of the skin of the feet.

Conclusion

In patients with diabetes, great attention should be paid to the prevention of complications such as diabetic neuropathy and diabetic foot syndrome. For such patients, a method of caring for the skin of the feet has been developed. At the first symptoms of dry skin, it is recommended to apply products with urea. Such products, in particular, include Balzamed and Balzamed intensive.

Treatment

Methods for moisturizing the skin are different and are largely determined by eliminating the source - the catalyst of the problem. If the cause is a specific disease, then treatment of dry skin of the body includes all the necessary measures that can stop the pathology, and hence remove its accompanying symptoms.

If the reason is different, then it is necessary to take measures to protect the skin from the negative influence of external irritants, which can be eliminated independently. It is necessary to keep the skin clean, but you should not overdo it with the amount of washing and taking baths and showers. Cosmetics for washing must be of high quality and match your skin type. You should use only high-quality, non-expired cosmetics. In winter, it is necessary to use protective creams. In everyday life, prefer clothes and shoes made from natural materials. This will protect against the occurrence of allergic reactions to artificial material and protect against thermal overheating of the skin. Anti-inflammatory agents must be used along with moisturizers. It is recommended to use anti-allergy medications or general health-improving medications internally, which will be prescribed by your dermatologist.

Skin thickening, or hyperkeratosis

Diabetes mellitus

Human papillomavirus (HPV)

Fungus

Menopause

Climax

14964 August 16

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Thickening of the skin: causes of occurrence, what diseases it occurs with, diagnosis and treatment methods.

Definition

Hyperkeratosis is an abnormal thickening of the top layer of skin (epidermis) as a result of excessive sun exposure, exposure to chemicals, frequent friction or pressure. In addition, hyperkeratosis can occur against the background of certain diseases.

Thickening of the skin occurs in the stratum corneum of the epidermis, which is the end point of the differentiation process of keratinocytes - cells containing the protein keratin. It is in the stratum corneum that keratinocytes lose water and their nucleus and turn into scales of the stratum corneum - corneocytes.

Normally, corneocytes are gradually exfoliated, due to which the skin is renewed.

With hyperkeratosis, accelerated differentiation of keratinocytes occurs, and the physiological exfoliation of horny scales from the skin surface, on the contrary, slows down.

Types of hyperkeratosis

Depending on the origin, acquired and hereditary hyperkeratosis are distinguished.

According to clinical manifestations.

Calluses are a common type of hyperkeratosis. There are several types of calluses, but they all appear due to thickening of the skin in places most susceptible to mechanical stress. Moreover, such skin changes can be associated both with increased physical activity and with various chronic diseases, which is typical for elderly patients.
Horny (tilotic) eczema manifests itself as hyperkeratosis of the palms and soles.
Psoriasis is an autoimmune inflammatory disease in which hyperkeratotic scaly plaques form on the skin.

Actinic keratosis usually appears as small, reddish, scaly bumps that appear after excessive sun exposure. Actinic keratosis is a serious condition with a high probability of malignancy and requires mandatory consultation with a doctor.

Seborrheic keratosis is characterized by small brown or black patches, usually located on the face, neck, shoulders and back. This is one of the most common benign skin tumors in adults.
Follicular hyperkeratosis (“goose bumps”) is characterized by blockage of the mouths of the follicles with keratinized epidermal cells.
Epidermolytic hyperkeratosis is a rare hereditary disease that appears immediately at birth. Newborns have reddish skin, sometimes covered with small blisters.

Possible causes of skin thickening
Skin hyperkeratosis can occur in people who neglect regular skin care procedures, as a result of which dead cells of the stratum corneum accumulate and form keratomas - benign neoplasms.

Our skin is constantly exposed to adverse external factors, such as chlorinated water and detergents, and UV radiation. As a result, the protective lipid layer of the skin is damaged, and moisture begins to rapidly evaporate from its surface, and corneocytes lose their ability to physiologically exfoliate.

In diabetes mellitus, hyperkeratosis becomes a consequence of metabolic disorders and deterioration of skin microcirculation.

Wearing tight or uncomfortable shoes, especially with flat feet, congenital foot pathologies, and obesity, can cause thickening of the skin on the feet.

The development of cervical hyperkeratosis (leukoplakia) is promoted by the human papillomavirus.

The cause of hyperkeratosis can be chronic fungal infection, as well as herpes zoster.

It is believed that symptoms of thickened and dry skin may be caused by a deficiency of vitamins A, E, D and C.

Hyperkeratosis often results from a lack of the hormone estrogen in women during menopause.

Diseases and conditions in which hyperkeratosis develops

Diabetes.
Obesity.
Flat feet.
Ichthyosis.
Psoriasis.
Eczema.
Menopause.
Fungal skin infection.
Shingles.
Erythroderma.
Atopic dermatitis.
Seborrheic keratosis.

Which doctors to contact for hyperkeratosis
Most often, the first consultation regarding skin thickening is addressed to a dermatologist. After a thorough examination, collecting complaints, finding out the patient’s medical and family history, conducting laboratory and instrumental studies, a consultation with an infectious disease specialist may be required.

Diagnosis and examinations for thickening of the skin

A thorough history taking, taking into account all the patient’s complaints, examination and additional diagnostic methods will help determine the cause of hyperkeratosis.

Clinical blood test with a detailed leukocyte formula to identify inflammatory processes in the body.