A 60-year-old man presents with hyperkeratosis and cracking of the skin on the palms of his hands and the soles of his feet that had developed over a 3-year period with no specific cause.
He had been treated by dermatologist using topical corticosteroids (Eloment, Daivobet) and oral antihistamines without much improvement. He felt severe itching and often scratched the lesions. He also took 2 months of Traditional Chinese Medicine prescribed by local physician, but received no improvment. Furthermore, after the cracking appeared on the soles, he dared not walk long distances due to the severe pain.
On clinical examination, there were several hyperkeratotic and erythematous lesions on the palms and soles. Lesions of tylosis-like yellowish severe hyperkeratosis were spread over the soles and plams (Fig. A).
He has been on amlodipine treatment 5 years for his hypertentsion. There was no family history of keratinization disorders. Tinea pedis and candidiasis were ruled out by direct microscopy at dermatologist office. Laboratory data showed no abnormalities. Serological tests for syphilis were negative. Tumor markers were within normal range.
Severe hyperkeratotic palmoplantar eczema (eczema tyloticum) was diagnosed, Tangs herbal medicine was given for 24 months, which provides excellent clearance of the hyperkeratotic eczema on his both palms and soles.