Siew Yim Loh
Background: Plantar keratodermas are a diverse group of hereditary and acquired keratodermas characterised by hyperkeratosis of the skin of the soles. Hyperkeratotic eczema of hand/feet typically chronic and refractory to therapy is still a poorly understood entity associated with pain mobility impairment and functional limitations.
Case report: This case report is on an idiopathic plantar hyperkeratosis in a 55 year-old Chinese female with no prior dermatology history. The patient presented to the skin clinic with a recurring left plantar dermatitis with frequent bleeding and skin breakdown 5-years ago. It then spread to both plantar especially on the lateral border of both feet about 3 years ago. Initial laboratory examination for fungal and patch tests returned with negative findings. On the 4th year a punch knife biopsy for malignancy was performed and results were negatives. Hyperkeratosis followed by skin breakdown continues until today.
Conclusion: Patient self-management approach to comprehensive care is needed for plantar-hyperkeratotic eczema to complement medical management as PKK takes a chronic form of illness. The medication regimes starting with antifungal antibiotic-steroid cream keratolytic agent and a course of acitretin tablets with regular outpatient wound-care dressing is insufficient for this case. Relief was unsustainable and symptoms recurrences impacted quality of life. Collaborative patient self management to properly engage patient in partnership with self-care strategies to target at resolution with minimal adverse effects (in terms of scarring crusting skin breakdown and bleeding) are needed with additional consideration of other personal-environmental causal factors.