What’s the best treatment for inherited hard skin on the palms and soles?

Palmoplantar keratoderma (PPK) is a condition where the patient has thick, hard skin on the palms and soles. It can cause considerable discomfort and impairment of function. This problem is sometimes inherited (hPPK). There are many varieties of hPPK which are all uncommon. They show considerable variation in presentation, severity, genetics and associated abnormalities. This study is an international collaboration between four members of the European Network for Rare Skin Diseases. Their aim was to search the literature published since 2008 looking for evidence to support the use of different treatments for hPPK. Initially they found 20,409 papers on the subject. However, after applying exclusion criteria this was reduced to a total of 42 publications, mainly of small case series and single case reports. The level of evidence to support any particular treatment was weak. The most effective treatment was the use of oral retinoids (Vitamin A derivatives). However, they were not universally efficacious and their tolerability varied. Local therapy in the form of creams to soften and break down the surface hard skin layer were helpful in most situations. Podiatrists play an important role in providing physical treatments such as paring of hard skin, providing protective insoles and appropriate footwear. Newer, experimental treatments based on increased understanding of the cellular mechanisms involved in hPPK are under investigation. Because hPPK syndromes can involve other body systems such as the teeth, eyes and ears, the authors stressed the importance of a multidisciplinary approach in managing these patients. Linked Article :  Bodemer et al . Br J Dermatol 2021; 184 :393–400.