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Hi there

I'm looking for dermatology opinion please.

43 year old lady with unilateral widespread plantar HPK. Painful fissures and rapid hyperkeratotic thickening of the right foot only. Condition is chronic; started quickly at 20 y/o. Left foot is completely soft/normal in texture.

Patient has had numerous serology requests over past two decades from GPs, consultant dermatologists and rheumatologists. Serology repeatedly includes ESR, CRP, FBC, ANA, Latex, Rh factor, HLA B27, Zinc, full thyroid tests. Always unremarkable results. Most recent full battery of bloods also shows patient not menopausal.

Skin/nail Scrapings and samples show nothing remarkable to fungal/ bacterial tests in NHS Lab.

Consultant NHS Dermatologist last year agreed with private dermatologist c.2012 (without comparing notes) that regular/monthly podiatry scalpel debridement should continue for pain relief. Diagnosed "idiopathic HPK thickening of plantar aspect". Also provided (by rx order) Propylene glycol:
Pour into paint tray .. stand in it for 10 mins each day.

Patient found with prop glycol over 6/12, only difference was podiatry visits could sometimes stretch to every 6/52 instead of every 4/52 before painful fissures on global plantar aspects became problematic (plantar digits / plantar forefoot areas / plantar mid foot and plantar heel area).

Patient doesn't have dry hands or any hand/digital issues. No issues elsewhere on body.

Patient has been a tobacco smoker for nearly 25 years. Patient diagnosed NIDDM type 2 in 2015 and is diet controlled. Patient otherwise fit and well, without fatigue or joint pain... works full time and has had varied career as nurse/chef/currently housewife. Has No children. Unremarkable biomechanical features. No LLD.

Any thoughts most appreciated!