Horny eczema: a disease of dentists and hairdressers

A rare variety of chronic eczema is horny eczema (eczema tyloticum). Often it is noted in persons of certain professions: dentists, flower growers, office workers, hairdressers.

With this form of eczema, there are no symptoms of acute inflammation of the skin in the form of edema, blisters and itching. On the skin of the palms there are limited foci of hyperkeratosis in the central or marginal zones of the palms and more or less deep cracks.

This chronic dermatosis is characterized by widespread symmetrical peeling of the skin of the palms. At the beginning, the peeling zones are small, up to 2–3 mm in diameter, and have rounded outlines. Gradually, they increase in size due to peripheral growth, merge, forming large rounded areas. The central zone becomes hyperemic and painful.

Complaints of patients are reduced to roughness and stiffness of the skin of the palms and pain in the area of ​​cracks. A special type of chronic eczema is eczema of the fingertips. The skin of the fingertips is pink-red, dry, flaky, cracked. Vesicles are not characteristic. Itching is minimal and often absent altogether. Soreness and burning sensation of the skin in the affected area are typical. The process is limited to the distal phalanx of one or more fingers.

Atopy may be a predisposing factor, irritants (detergents, contact with water, friction), allergens (adhesives, medicines, foods, plants) may play a role. Often observed in persons of certain professions: dentists, flower growers, office workers, hairdressers. The process tends to be protracted for a long time. In a number of patients, the process, starting at the fingertips, slowly spreads to all fingers and palm and turns into exfoliative keratolysis. 

Haxthausen Syndrome

Approximately 20% of the group suffering from horny eczema is occupied by patients with climacteric palmoplantar keratoderma (Haksthausen's syndrome). Dermatosis is an acquired form of diffuse keratoderma. The disease affects mainly women in the 5th decade of life. In men, the disease is observed less frequently and at a later age – between 50–60 years. The development of the disease is facilitated by estrogen deficiency, a decrease in the functional activity of the thyroid gland. 

Quite often, patients have somatic diseases comorbid to dermatosis: obesity, hypertension, cardiovascular diseases, deforming arthritis. The skin of the palms and / or soles, starting from the central zone, is gradually covered with horny layers, the number of which slowly increases both in volume and in area. The horny masses crack, there is pain in the area of ​​​​the foci, especially when walking, and a slight itch. 

Hyperkeratotic stratification may be diffuse or focal with increased horny stratification along the edge of the palms and soles. Hyperkeratosis is especially pronounced in places of pressure and friction. Some patients may have foci of keratosis, incl. with psoriasiform peeling and on other areas of the skin, primarily on the extensor surfaces of the limbs (elbows, knees).