Induration Skin Hardening Signs and Causes

Skin induration is a deep thickening of the skin that can result from edema, inflammation, or infiltration, including by cancer.

Diagnosis of skin induration is made by palpation (feeling) the area and assessing whether the raised area has a hard, resistant feeling. Because there are many different underlying causes of induration of skin, the treatment varies widely. 

skin induration

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Signs of Induration

Indurated skin generally has the following signs:

  • Hardened skin
  • Feels firmer to the touch than surrounding skin
  • Appears thick
  • Looks smooth and shiny

The indurated areas commonly appear on the hands and face but can also be found on the chest, back, abdomen, breasts, or buttocks.

Causes of Induration

The primary underlying causes of skin induration include:

  • Specific types of skin infection
  • Cutaneous metastatic cancers
  • Panniculitis

The precise physiological process that results in many conditions that cause skin induration includes the inflammatory process and infiltration of the skin by certain types of cancer cells.

Skin Infections

There are several types of skin infections that can manifest with symptoms of skin induration, examples include:

  • An abscess
  • An inflamed cyst
  • Insect bites that become infected

Not only is there an underlying skin condition that can cause infections that exhibit skin induration, but there is also a causative microorganism. According to a Baylor University Medical Center study, staphylococcus aureus is responsible for the majority of skin and soft tissue infections.

Cutaneous Metastatic Cancers

Cutaneous metastasis occurs when cells from a cancer in the body spread to the skin. Metastatic skin lesions may originate from various other types of cancer.

Another source of cutaneous metastasis is skin cancer. In this instance, the primary melanoma spreads/infiltrates to distant areas of the skin, where secondary growths begin to surround the primary melanoma site.

Scleroderma

Scleroderma (systemic sclerosis) is a rare condition involving inflammation and fibrosis of the skin and internal organs. There are three phases of the disease, and the second phase involves skin induration. The condition is linked with significant illness and mortality rates.

Diabetes

Diabetes can cause a condition called recurrent plantar ulcers, which are ulcers or sores on the bottom of the feet (due to poor circulation to the lower extremities).

Studies have shown that induration on the soft tissue of the feet may cause an increased risk of recurrent foot ulcers in diabetics because it results in a decrease in the foot’s ability to absorb shock when a person is bearing weight.

Panniculitis

Panniculitis is an inflammation within the fat tissue of the body and has many underlying causes, including:

  • Infections
  • Inflammatory disorders (such as lipodermatosclerosis)
  • Trauma or exposure to the cold
  • Connective tissue disorders
  • Pancreatic disorders

Symptoms of panniculitis may include reddened, tender nodules (indurated areas of the skin) over the chest, abdomen, breasts, face, and buttocks.

Diagnosis of panniculitis is most often made by visual examination in combination with doing a biopsy for confirmation.  

Treatment

Treatment of induration of skin varies greatly depending on the underlying cause. 

Example treatment options may include:

  • For an abscess, the treatment of choice may be antibiotics, incision, or drainage.
  • For inflammatory disorders, like scleroderma or lichen sclerosus, immunosuppressants or steroid creams can be used.

Supportive care

Supportive care for conditions involving skin induration can vary greatly, depending on the underlying cause. Examples of supportive care for skin conditions may include:

  • Warm compresses
  • Analgesia
  • Elevation of the affected extremity (to help reduce any swelling)

A Word From Verywell

Many skin conditions require close follow-up care, particularly if symptoms begin to worsen and/or if treatment (such as antibiotics) is ineffective. Skin infections are commonly resistant to certain types of antibiotics; therefore, if a fever develops, the induration gets larger, or the area becomes reddened and hot to touch, it is vital to consult with the healthcare provider as soon as possible. Your antibiotic may need to be changed to a different type of medication.

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Article Sources
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  2. Race E, Berthelot C, Cather JC. Painful nodule with induration and spreading erythema. Baylor University Medical Center Proceedings. 2005;18(4):401-404. doi:10.1080/08998280.2005.11928101

  3. DermNet NZ. What is cutaneous metastasis?

  4. Rheumatology Network. Skin hardening, but is it systemic sclerosis? Updated March 31, 2009.

  5. Brink T. Induration of the diabetic footpad: another risk factor for recurrent neuropathic plantar ulcers - verhärtung der diabetischen fußsohle - eine prädisposition für rezidivierende neuropathische fußgeschwüre. Biomedizinische Technik/Biomedical Engineering. 1995;40(7-8):205-209. doi:10.1515/bmte.1995.40.7-8.205