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Punctate Keratoderma?

Discussion in 'General Issues and Discussion Forum' started by Zac, Apr 16, 2013.

  1. Zac

    Zac Active Member

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    Female patient 45. Healthy. Non-smoker. Presented with bilateral burning of the plantar foot due to heavy callus. Has suffered from this for as long as she could remember. Has not been overly bothered by it in the past & never sort a definitive diagnosis.

    I apologise that photos were taken post debridement & they were hurriedly taken with an iPhone. I am trying to upload 2 pictures.

    My initial diagnosis - Punctate Keratoderma. I have suggested a referral to a Dermatologist. What other treatment options are there other than basic debridement?

    Attached Files:

  2. jos

    jos Active Member

    Yep that's it. This patient will be a regular at your clinic!

    JAYNES Active Member

    Hi zac
    I have a female patient also with punctate Keratoderma 62 years of age.
    She also complains of burning when plantar areas are heavily callused .
    She has treatment every 4 weeks
    She finds this gives her relief , she applys heel balm daily.
    Her father had the same condition and her daughter has also inherited the condition.
  4. blinda

    blinda MVP

    Nice pic :drinks

    Agreed on Punctate Palmoplanter Keratoderma (PPK). Topical retinoids and sal acid can help, but there is no magic bullet. It is often autosomal and does not always affect the hands.

    Taken from here;

  5. despina

    despina Welcome New Poster

    I also have a female patient in her 30s with the same problem. She benefits from regular debridement and use of emollients.
  6. Zac

    Zac Active Member

    Thanks to everyone for confirming my diagnosis.

    Further questions:
    1. Is there benefit in seeing a Dermatologist?
    2. What specific emollients would be most beneficial eg. Heel Balm?
    3. What preparation of salacylic acid may be most beneficial?
  7. blinda

    blinda MVP

    1, Yep, they can prescribe oral retinoids and advise on latest evidenced based tx.
    2, Urea based emollients, NOT aqueous cream. http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=67647
    3, 6% sal acid in white soft paraffin, or a gel of 6% sal acid in 70% propylene glycol.
  8. Zac

    Zac Active Member

    As a general emollient, what do most people like to use/recommend? Im just asking for the pateints who have that general dry skin type what do you recommend? Do you prefer the urea based creams (e.g. those by Walkers) or Heel Balm type products or Pedimed?? I have regularly used urea products but have liked & so have patients, the Pedimed product (I am not a rep & I have no vested interest in the product). I know there are many out there but curious what Australian Podiatrists prefer (I say Australian because products used overseas may not be available here).
  9. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Great - from the opening photo to the following contributions, shows Podiatry Arena at its best.
  10. carolethecatlover

    carolethecatlover Active Member

    This looks a lot like Dyshidrosis. Dyshidrosis that has imploded within the layers of skin and rose to the surface as a dry blister. On google images, lots of the images are pitted keratolysis and dyshidrosis. Obviously, there is confused diagnosis here. The fact that it responds to retinoids gives credence to my belief that it is a different manifestation of the same causes. A fungal infection causing a histamine reaction. Until Dr Ruzicka came along and showed that dyshidrosis could be cured by retinoids, doctors were saying it was 'autosomal' and 'caused by stress'. But now, like stomach ulcers, we have an inciting cause and a cure.
    I would really like to test out the vitamin A protocol on a case of PPK.
    If it itches, the patient should take Fexofenadine 180mg per day. If this stops the itching, it is a pretty sure sign that it is an allergic reaction (to the presence of a dermatophyte).
    Very, Very Interesting and thank you for posting.
    (I have not seen a case in the flesh.)
  11. Tkemp

    Tkemp Active Member

    I was a patient in his early 20's with PPK. It is not helped by the fact he has to wear steel soled boots to work - which contributes to the increased formation of plantar HK (IMHO).
    Regular debridement and the use of Eulactol (a heel balm containing urea) appears to be providing relief.
    Zac - Eulactol is available in most Australian chemists/pharmacies. If you have patients who struggle to afford urea based creams then Chemist Warehouse (I have no links with this company is any shape or form) sells these products at reduced prices.
  12. kc

    kc Member

    Great debriding- must have taken ages! I also had a patient with this condition and on his first visit with me, which was also his first ever podiatry consultation at the age of 80 , he only complained that his socks were difficult to take on and off as something was catching on them . As he had the condition for many years, with no pain , he just wanted the straggly bits cut off . After being there so long they had also grown outwards and created little "tails" which were the sock culprits. Never had an improvement in the number or depth of the lesions , nor did he feel any better for having them removed , which made me question why i toiled so diligently to enucleate them all, but the sock issue was resoved...

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