The climacteric keratodermiya – chronic keratodermatit the climacteric period, caused by a lack of estrogen of an organism. It is symptomatic shown by spontaneously arising centers of a giperkeratoz on palms and soles significantly reducing quality of life impeding walking and the implementation of homework because of emergence of cracks on skin. Primary element is the flat papule tending to merge and peripheral growth. Rashes are followed by the itch amplifying at night. Diagnostics is clinical, confirmed with histologic researches. Therapy pathogenetic (ZGT) and symptomatic (keratolitik, regeneration stimulators, local bathtubs).
Climacteric keratodermiya (Hakstkhauzen's syndrome) – hypoestrogenic climacteric dermatitis with primary violation of processes of a keratinization in a horn layer of epidermis. Pathology has bright gender coloring. About 20% of women are ill 45 years are more senior. The first dermatologist who described clinic of this form of a keratodermiya and connected it began with a climax, there was Englishman Henry Brook in 1891. He devoted a big half of the life to studying of "a keratin dermatosis", having opened in 1886 follicular , and then an unusual epitelialny nevus. In 1934 Hakstkhauzen in details gave the description of 10 clinical observations of women of climacteric age with the keratotichesky damage of palms and soles which had the deep cracks of skin bringing them the real sufferings. He assumed existence of communication between giperkeratozy and pathology of ovaries. But only in 1943 Peter Lynch defined the leading factor in development of this pathology – deficiency of estrogen. Relevance of a problem is defined by possible interrelation of a climacteric keratodermiya with chronic neoplastic processes in an organism of patients today.
Reasons of a climacteric keratodermiya
The modern dermatology considers Hakstkhauzen's keratodermiya of one of the making symptoms of a climax connected with age exhaustion of function of ovaries. As neuroendocrine regulation traffic of skin is carried out through the hormones of ovaries "working" in close contact with a thyroid gland under control of TsNS, the general condition of skin directly depends on a hormonal background of the patient. In the course of physiological aging there is a reorganization of this background. In the natural way the level of estrogen decreases, transport of normal fabric structures of proteins, fats, carbohydrates, necessary for construction, at once decreases. The hypothalamus tries to compensate this shortage by the strengthened work of other systems under control to it owing to what there are such phenomena as and tachycardia, there is a narrowing of vessels, increase in protective properties of skin.
To one of mechanisms of strengthening of such protection serve the minimum deskvamation (slushchivaniye) of cages horn, a blanket of the epidermis which is directly contacting to external factors. In this case at development of a giperkeratoz of a cell of epidermis not just begin to share with the doubled speed as at other keratoza, and degenerate as a result of violation of exchange processes in skin. The proteins responsible for a keratinization are produced prematurely, breaking a ratio of the components participating in processes of an orogoveniye. Cells of epidermis do not manage to receive because of violation traffic of skin necessary nutrients, their fermental systems work with the minimum power expenses, lipidic exchange is broken, cytoplasm is overflowed with a keratin which forces out a kernel and organellas from a cage and in the form of horn scales appears on a surface.
At the same time around pathologically developing cages there is an inflammation, the substance cementing horn cages is produced. These are lipidic inclusions of myelin type. Normal on the surface of skin there is a dynamic balance between the cages of a horn layer and living cells of a basal layer succeeding them. It determines thickness of epidermis and a horn layer. At reduction of synthesis of estrogen proliferation of cages decreases, their deskvamation decreases, and epidermis thickness at the expense of the cages of a horn layer remaining on a surface increases. Surplus of dead cages forms the keratodermiya centers on the surface of skin.
Symptoms of a climacteric keratodermiya
Primary element of a climacteric keratodermiya is the inflammatory eritema against the background of which pour out the papular elements of the small sizes tending to merge and diffusion distribution on all surface of palms and soles on which pathological process is most often localized. Papules are covered with silvery scales. The rash occurs in the dehydrated option therefore skin dry, shelled. Over time giperkeratotichesky stratifications thicken an integument surface, because of dryness in the thickness of the keratozny centers there are deep cracks causing strong pain. Damage of skin is symmetric, cracks are localized more often in places of pressure upon skin, that is at the edges of palms, soles, however can strike the sgibatelny surfaces of elbow and knee joints, other sites of an integument.
Subjective symptoms correspond to a climax: inflows, perspiration, fever, heartbeat, increase HELL. Patients are tormented by a severe itch, it is more at night. Raschyosa, a secondary infection join primary rashes, the clinical picture reminds "dry" eczema. Nails are involved in process. They grow turbid, are thickened, become fragile, the okolonogtevy bed inflames, on perimeter agnails appear. Knocking over of symptoms of a climax leads to self-permission of skin manifestations. However, if the keratodermiya developed against the background of the existing latent or obvious tumoral process, its malignization is possible.
Diagnostics and treatment of a climacteric keratodermiya
The clinic of a disease is typical, does not raise doubts in diagnostics. Resort to a histologic research seldom. The histopathology is not specific: the phenomena hyper - and a parakeratoza with lymphoid infiltration, a degeneration of collagenic and elastichesky fibers terms. The scrape microscopy from the center on mushrooms and consultation of the gynecologist-endocrinologist is obligatory. Differentiate a disease with other forms of a local giperkeratoz, Sukhoi of a form of true eczema, psoriasis, red flat ё, rubromikozy, a keratodermichesky sifilid.
Therapy is pathogenetic, it is directed to completion of a lack of estrogen. In parallel apply , vitamin therapy (And, E), keratolitichesky ointments, wound healing medicines. Heat soda baths, bathtubs with a camomile, a sage give good effect. The forecast rather favorable taking into account a frequent recurrence and violation of quality of life.