What Is Hyperkeratosis?

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Hyperkeratosis is a skin condition that causes the outer layer of skin, known as the stratum corneum, to thicken and harden.

The stratum corneum is made up of a protein known as keratin. When the body produces too much keratin, skin issues can occur.

This article discusses the types, causes, and treatment options for someone who develops this skin condition.

Eczema skin

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Types of Hyperkeratosis

"Hyperkeratosis" is an umbrella term for skin conditions that develop from excess amounts of keratin. There are various types of hyperkeratosis, each marked by its cause.

Hereditary Types of Hyperkeratosis

Some types of hyperkeratosis develop due to a hereditary component. Examples include:

  • Epidermolytic hyperkeratosis
  • Multiple minute digitate hyperkeratosis (MMDH)
  • Focal acral hyperkeratosis
  • Lamellar ichthyosis
  • X-linked ichthyosis (XLI)
  • Keratosis pilaris, otherwise known as follicular hyperkeratosis

Acquired Hyperkeratosis

Other forms of hyperkeratosis are acquired later in life. It’s not always clear what the cause of each type is. Some acquired hyperkeratosis conditions include:

Acquired vs. Hereditary

Hereditary conditions are passed down through families. Often if a person is related by blood to someone with a genetic disorder, their risk of getting it is a lot higher. Acquired conditions, on the other hand, develop for many reasons unrelated to genetics.

Hyperkeratosis Symptoms

The main symptom of hyperkeratosis is thickened skin that feels rough to the touch. Other symptoms may be present with hyperkeratosis depending on the type.

For example, if a person has keratosis pilaris, a hereditary type of hyperkeratosis, they may also experience redness in the affected skin area.

Common symptoms of hyperkeratosis include:

Symptoms by Type of Hyperkeratosis
Epidermolytic hyperkeratosis Red skin; severe blisters; thickening and darkening of the skin on the joints, scalp, or neck; distinct odor coming from the areas affected
Multiple minute digitate hyperkeratosis (MMDH) White, yellow, or brown lesions; dome- or crater-like papules (tiny bumps); areas of skin that form into spikes
Focal acral hyperkeratosis Waxy, yellow, and firm papules on the skin mainly occurring on the hands and feet; plaques (raised lesions) on the knees
Lamellar ichthyosis Clear, shiny, and waxy layer of skin (collodion membrane) that sheds after two weeks; scaly and red skin underneath the collodion membrane
X-linked ichthyosis (XLI) Scaly skin on the neck, trunk, and lower extremities that are dark brown or gray
Plantar hyperkeratosis The development of corns and calluses, typically occurring on the palms, knees, or bottom of the feet, that can cause pain and immobility
Hyperkeratosis of the nipple and areola Thickening of the nipples and areola and skin lesions that are darker and thicker than they typically are
Lichen planus Flat purple bumps on the skin; itching; blisters that scab over; white patches within the mouth; sores in the mouth or vagina; hair loss
Seborrheic keratosis A benign slightly raised growth that is brown, black, or light tan in color and waxy and scaly looking
Hyperkeratosis lenticularis perstans (HLP) Papules that are typically asymptomatic (have few if any symptoms) but can bleed if they are scratched or torn off the skin
Actinic keratosis Rough and dry scaly patches of skin; flat or slightly raised bumps; wartlike bumps; discoloration to pink, red, or brown; itching, burning, bleeding, and crusting of the affected area

Recap

All types of hyperkeratosis present differently depending on the type, cause, and area of the body affected. 

Causes

There are two types of hyperkeratosis depending on how they develop, which are:

  • Pressure related
  • Nonpressure related

Pressure-related hyperkeratosis occurs when the skin is irritated or inflamed. In response to the pressure, the body produces more keratin to combat the damage to skin cells but does so too quickly. Acquired forms of hyperkeratosis can be pressure-related. 

Nonpressure-related types of hyperkeratosis are caused by genetics. Inherited hyperkeratosis develops when changes to a specific gene occur in families, and those changed genes are passed down. Different genes play a role in each type of hyperkeratosis.

Recap

The causes of hyperkeratosis are either pressure related or nonpressure related.

Diagnosis

To get a diagnosis of hyperkeratosis, you must visit a healthcare provider. They will do a physical examination of your skin, as well as ask about the symptoms you are experiencing and your health history.

Since there are so many different conditions associated with hyperkeratosis, knowing the symptoms accompanying the thick and rough patches will be necessary to come to a final conclusion. 

A skin biopsy is often necessary to help the healthcare provider determine what type of condition is causing hyperkeratosis. A skin biopsy involves the removal of skin so it can be examined under a microscope.

Recap

Getting the correct diagnosis is vital before beginning treatment so that your healthcare provider offers the right one.

Treatment

Hyperkeratosis is, for the most part, highly manageable through various courses of treatment. The most effective treatment options for the varied types of hyperkeratosis include:

That said, each type will have its own treatments. They can include:

Hyperkeratosis Treatments
Epidermolytic hyperkeratosis  Gene therapy, sea salt baths, oral retinoids 
Multiple minute digitate hyperkeratosis (MMDH) Retinoids, keratolytics, surgical removal of lesions, avoiding gluten 
Focal acral hyperkeratosis Keratolytics, no treatment at all 
Lamellar ichthyosis Moisturizers, retinoids
Keratosis pilaris Exfoliation and moisturizing daily, sun exposure to minimize the appearance
X-linked ichthyosis (XLI) Moisturizers and exfoliants, oral retinoids, creams containing lactic acid (a keratolytic)
Plantar hyperkeratosis Keratolytics, removal of horn-like skin accumulation to provide relief to the area
Hyperkeratosis of the nipple and areola Retinoids, no treatment at all
Lichen planus No treatment if symptoms are mild, corticosteroid creams, mouthwashes, or ointments, oral corticosteroids, ultraviolet A (UVA) light therapy, antihistamines, emollients 
Seborrheic keratosis Cryotherapy (the use of freezing temperatures), surgical removal of affected plaques and lesions, alpha hydroxy acids
Corns and calluses Removal using a trimmer or scalpel, changing shoes to reduce foot friction, the use of insoles to cushion the feet to reduce pressure, surgery in recurring cases 
Hyperkeratosis lenticularis perstans (HLP) Antimetabolites designed to reduce excess skin cell growth, surgical removal of the lesions, dermabrasion, oral retinoids
Actinic keratosis  Emollients, antimetabolites, immunoregulating medications to help moderate the immune system response, cryotherapy, phototherapy, laser therapy, burning off the lesions using electricity
Warts Cryotherapy, salicylic acid designed to encourage faster shedding of dead skin cells

When to Call a Healthcare Provider

Make an appointment with your healthcare provider to discuss symptoms and treatment. Your provider will investigate your condition and advise you on which treatment will work best for you. In some cases, treatment is unnecessary.

Prognosis

Many forms of hyperkeratosis are non-life-threatening and manageable. In fact, most types are simply cosmetically unpleasing. That said, rare hyperkeratosis conditions can have severe health consequences.

For example, actinic hyperkeratosis is a precancer and has the potential to develop into skin cancer.

What to Do If You Have Seborrheic or Actinic Hyperkeratosis

Since both seborrheic and actinic hyperkeratosis can develop into skin cancer, it is essential to get regular checkups to monitor your condition professionally. Even if you are managing it effectively, be sure to have skin cancer screenings and watch for any abnormal changes. 

Coping

Coping with a skin condition like hyperkeratosis isn’t always easy because of physical and cosmetic symptoms. However, with the proper treatment, you will be able to manage your symptoms and improve the visual appearance of your skin.

Summary

"Hyperkeratosis" is a blanket term used to describe various skin conditions. The health conditions associated with hyperkeratosis have different symptoms. However, they one thing in common: the excess production of keratin.

Hyperkeratosis can be hereditary and passed down through families, but it can also develop later in life because of different factors. Some forms of the condition have no known cause.

Hyperkeratosis may take time to diagnose. Work with your healthcare provider to determine the underlying cause of your skin condition. Once that is done, you can begin the proper treatment to manage your skin condition.

A Word From Verywell

A skin condition can be challenging to deal with, especially if it causes painful symptoms. The good news is that dealing with most forms of hyperkeratosis is manageable with the proper treatment. In most cases, this condition is not severe or life-threatening.

The best thing you can do if you have hyperkeratosis is to speak to a dermatologist (a medical doctor specializing in conditions of the skin, hair, and nails) about your condition and any concerns you have. They will be able to determine the next steps to address your condition.

Frequently Asked Questions

  • What causes hyperkeratosis?

    The cause of hyperkeratosis depends on the type. Some are genetically inherited, while others are acquired later on in life. The cause of hyperkeratosis is not always known.

  • How to treat hyperkeratosis?

    The treatment for hyperkeratosis will depend entirely on its type and the underlying cause. Treatment isn't always necessary because some forms of hyperkeratosis are either asymptomatic or present with mild cosmetic symptoms. The most common forms of treatment include keratolytics, moisturizers, emollients, and retinoids.

  • Should you get your hyperkeratosis removed?

    Not all types of hyperkeratosis can be removed surgically, although it is a promising treatment option for certain types. If you wish to have your lesions or thick skin addressed surgically, speak to your healthcare provider about your options.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Jakeman A. The effective management of hyperkeratosis. Wounds Int. 2012;1:65-73. 

  2. National Human Genome Research Institute. Genetic disorders.

  3. Tian Y, Li XX, Zhang JJ, Yun Q, Zhang S, Yu JY, Feng XJ, Xia AT, Kang Y, Huang F, Wan F. Clinical outcomes and 5-year follow-up results of keratosis pilaris treated by a high concentration of glycolic acid. World J Clin Cases. 2021 Jun 26;9(18):4681-4689. doi:10.12998/wjcc.v9.i18.4681

  4. Harvard Health Publishing Harvard Medical School. Hyperkeratosis.

  5. National Organization for Rare Disorders. Lamellar Ichthyosis.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.