Hyperkeratosis

Question 1

what is hyperkeratosis

Answer 1

hypertrophy of the stratum corneum resulting in excessive keratin formation

Question 2

what can cause hyperkeratosis (7)

Answer 2

1. anhidrosis
2. bony deformities/prominences
3. mechanical pressure from footwear/gait
4. genetics
5. smoking
6. vitamin deficiency
7. inflammatory skin disease

Question 3

what are the characteristics of a physiological callus

Answer 3

1. its a normal response to pressure/injury
2. is the stimulus is removed, the stratum corneum usually recovers

Question 4

what are the chatacteristics of a pathological callus

Answer 4

1. if hyperkeratosis acumulates enough to cause pain, and persits despite removal of stimulus
2. may lead to ulceration, particularly when nutrition of the tissues is impaired

Question 5

how do dermal and epidermal cells react to mechanical stress

Answer 5

• they produce inflammatory cytokines, which result in incomplete differentiation of corneocytes
• in some genetic conditons (ichthyoses, keratiderma) mutatuions in keratin-encoding genes cause defects in keratin structure

Question 6

what is the term used to describe proliferation of all epidermal layers, including the stratum corneum

Answer 6

acanthosis

Question 7

what is parakeratosis

Answer 7

stratum corneum cells retain their nuclei

Question 8

what risk factors are associated with hyperkeratosis in diabetic patients

Answer 8

higher risk of foot ulceration

Question 9

how does hyperkeratosis commonly present in the foot (3)

Answer 9

1. callus
2. corns
3. fissures e.g., plantar, calcaneal

Question 10

how do corns differ from callus (4)

Answer 10

1. focal papules of dry, rough skin
2. common over bony prominences
3. flesh coloured with a whiteish centre
4. usually painful on direct pressure

Question 11

where might corns/ callus be seen on the foot

Answer 11

high pressure areas such as:
* plantar MTPJ
* plantar calcaneus
* lateral 5th IPJ
* interdigital

Question 12

where would a corn typically present in hallux limitus

Answer 12

2nd MTPJ

Question 13

where is it common to see a corn in HAV

Answer 13

medial 1st MTPJ

Question 14

where is it common to see a corn in the case of a tailor’s bunion

Answer 14

lateral 5th MTPJ

Question 15

what are the features of intractable plantar hyperkeratosis (IPK) (5)

Answer 15

1. very painful
2. central fibrosis may be observed
3. neurovascular elements
4. more prevalent in smokers
5. aka neurovascular corn

Question 16

infectious pathologies that feature hyperkeratosis (2)

Answer 16

1. verruca pedis/ warts
2. fungal infection

Question 17

non-infectious pathologies that feature hyperkeratosis (7)

Answer 17

1. keratoderma
2. ichthyoses
3. psoriasis
4. lichen planus
5. eczema
6. seborrheic keratosis
7. actinic (solar) keratosis

Question 18

objectives of hyperkeratosis management

Answer 18

• provide relief
• address extrinsic factors
• promote self-care
• consider intrinsic factors and non-conservative measures if required

Question 19

management interventions (3)

Answer 19

1. conservative
2. surgical
3. pharmaceutical

Question 20

how to provide pressure relief (5)

Answer 20

1. footwearmodification
2. insole fabrication
3. silicone devices
4. padding materials
5. casted devices

Question 21

other than sharp debridement, what are alternative methods

Answer 21

caustics