Pachydermia

Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.

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The doctor describes thickened and / or hardened skin or mucous membrane as pachydermia or pachyderma (colloquially also elephant skin). Depending on the trigger, this is treated with medication, creams and rarely surgically. Skin thickening can form due to repeated inflammation of the skin, for example as a result of diseases such as neurodermatitis. Read here how you can prevent skin thickening and what can help against it!

Brief overview

What is pachydermia? thickened, hardened skin or mucous membrane
Treatment: The treatment depends on the trigger of the skin thickening. Creams, tinctures, ointments and medicines are used, among other things.
Causes: Enlarged skin cells caused by skin irritation (e.g. friction or pressure) and / or diseases (e.g. neurodermatitis)
Diagnosis: conversation with the doctor, physical examination (measurement of skin density if necessary)
Prevention: skin care with special creams and ointments (water-oil emulsions), balanced diet

What is pachydermia?

Pachydermia is the technical term for excessively thickened and / or hardened skin or mucous membrane. It is also known colloquially as an elephant skin. Skin thickening usually develops as a result of recurring inflammation of the skin. These occur with certain diseases such as psoriasis or neurodermatitis.

Skin thickening or hardening of the skin can also occur if those affected put excessive strain on the skin in a certain area. The skin thickens to protect the underlying tissue (called the cornea).

A special form of skin thickening is pachydermia of the vocal folds, which is also a precursor to vocal fold cancer. The mucous membrane and the glandular tissue (squamous epithelium) that cover the surface of the vocal folds thicken.

What helps against elephant skin?

After the doctor has found the cause of the thickening of the skin, he and the person concerned decide on the further treatment steps. These depend on the trigger of the skin thickening.

Treat underlying disease

If the person affected is suffering from neurodermatitis and this is responsible for the thickening of the skin, the doctor will treat the underlying disease. For example, he prescribes lipid-replenishing and moisturizing skin creams that relieve itching.

Medicines such as cortisone are also used especially for neurodermatitis and other inflammatory diseases. These inhibit inflammatory messenger substances in the body and thus alleviate the symptoms that occur.

Avoid skin irritation

If the skin is thickened as a result of external skin irritation (e.g. pressure or friction), dermatologists recommend avoiding the triggering irritation. For example, if you have calluses on your feet, make sure not to wear shoes that are too tight.

Skin care

Proper care is also important for skin thickening. The main thing is to provide the skin with sufficient moisture.

Creams and ointments

Cream your skin with special skin creams and ointments. Depending on the condition of the skin, dermatologists recommend either highly moisturizing and / or fatty agents. Water-in-oil emulsions (W / O emulsions), for example, provide the skin with sufficient moisture and keep it supple. This strengthens the natural protective barrier, makes it more resistant and less sensitive to external influences.

Care creams with urea (urea) are also suitable. The urea it contains binds moisture in the upper layers of the skin and protects the skin from drying out.

Remove the callus

The skin forms calluses as a natural protective reaction against friction or pressure (e.g. from shoes that are too tight). In principle, the callus does not have to be removed. If you find the excessive callus, for example on your feet, annoying, it is possible to remove it.

The callus can be carefully removed with appropriate aids such as pumice stones, callus files and callus rasps. Before treatment with files and planes, doctors recommend a foot bath to soften the callus. This makes it easier to solve. A nourishing peeling helps to remove excess skin flakes and smooth the surface of the skin.

To avoid possible injuries when removing stubborn calluses, doctors recommend professional (medical) foot care (e.g. from a podiatrist).

Callus-dissolving formulations from the pharmacy that contain salicylic acid and urea are also suitable for removing calluses. They penetrate the skin and facilitate the detachment of the outer skin cell layers. The skin flakes faster and is stimulated to renew itself at the same time. Urea also reduces the growth of microorganisms on the skin (e.g. fungi, bacteria) and binds water in the horny layer. This makes the skin smoother and more supple.

Salicylic acid also has an antibacterial and anti-inflammatory effect. Skin irritation can heal faster. The remedies with salicylic acid and urea are available in pharmacies in both liquid (e.g. solution, tincture) and semi-solid (e.g. cream, gel, ointment) dosage forms.

Ask your doctor or pharmacist which agents and care products are best for your skin and how to dose them.

surgery

In some cases, the thickened cornea is a sign of chronic inflammation of the skin (dermatitis). It is pitted and calluses (tyloma) develop. If those affected have pain as a result (e.g. with a corn) or if they perceive the changes in the skin to be visually extremely disturbing, the doctor will also remove the skin thickening surgically. To do this, the person concerned first takes a foot bath with warm water to soften the cornea. The doctor then carefully removes the superfluous corneal layers using a suitable instrument (e.g. burr or scalpel).

Correct foot misalignments

If the cornea is formed by pressure points as a result of a foot misalignment (e.g. with a flat or splayfoot), those affected can relieve them by wearing wide-cut and comfortable shoes. In addition, insoles and special training of the foot muscles can help to correct the deformity and thus take the pressure off the stressed skin.

If that doesn't help, an operation is also possible or necessary to correct the misalignment of the foot. For the doctor, symptoms such as persistent pain, inflammation in the toe joints and / or a disturbed gait pattern are decisive for an operation. If the misalignment of the foot is corrected, the calluses and calluses will also recede.

Is Pachydermia Curable?

Skin thickening is basically curable. If those affected avoid the underlying trigger and the doctor treats the affected skin area correctly, the thickened skin can also be eliminated. In many cases, it is possible for those affected to successfully treat the skin thickening themselves at home.

How is elephant skin made?

In pachydermia, the outer cell layer of the skin (epidermis or epidermis) is stimulated to enlarge (so-called hypertrophy). The most common causes are certain diseases and long-term irritation of the skin.

Decreased sebum production (sebostasis)

If the sebum glands do not secrete enough sebum, the skin loses water and thickens. In more than 80 percent of cases, sebostasis is age-related, as sebum production naturally decreases with increasing age. In women, for example, changes in the hormonal balance during menopause are responsible for the fact that the skin produces less sebum and thus becomes dry.

Other causes of sebostasis are: vitamin deficiency (e.g. vitamin C, E and A), lack of fluids, external influences such as excessive UV radiation from prolonged sunbathing, air polluted with dust and exhaust gases, synthetic cosmetic products (e.g. with substances such as polyethylene glycol, parabens , Paraffins, silicones, artificial fragrances, emulsifiers).

Chronic skin diseases

As a symptom of chronic skin diseases such as neurodermatitis (atopic eczema) or psoriasis, skin thickening (so-called lichenifications) also occurs. As a result of the disease, the skin becomes keratinized and thickened. It often looks leathery as a result.

The skin is often thickened and less elastic, especially around the wrists, elbows and hollows of the knees. Even with a contact allergy, in which eczema forms through contact with certain substances (e.g. metals, cleaning agents, latex), the skin sometimes thickens.

Long-lasting stress on the skin

If the skin is permanently stressed at a certain point, it reacts with what is known as hyperkeratosis. In the process, healthy skin cells die off and turn into dead horny cells. The skin thickens, and calluses develop (also called tylom, callus or skin callus). It protects the skin from external influences such as friction or pressure and often occurs on the foot (on the balls of the feet and heels).

Cornea can also develop on the hands and (with appropriate stress) in other parts of the body. It usually forms where the skin is exposed to friction and pressure over a long period of time. The best-known form of the tyloma is the so-called corn on the foot. It occurs, for example, when shoes that are too tight put a permanent strain on the skin.

In most cases, the cornea is harmless and treatable. However, in the event of pain or significant skin changes, it is advisable to consult a doctor!

Symptom in other diseases

Extensive thickening or swelling of the skin is also a symptom of other diseases. These include, for example:

Cutis verticis gyrata: a rare congenital disease in which the scalp is malformed and wrinkles develop
Pachydermoperiostosis: a rare, inherited condition in which, among other things, the skin thickens and wrinkles form
Lichen myxoedematosus and scleromyxedema: rare skin disease in which lichen-like nodules (poplars) appear on the skin and the skin thickens and hardens over a large area
Erythropoietic protoporphyria: rare metabolic disorder; the skin itches, burns and reddens from exposure to the sun; the skin thickens
Interaryt (a) enoid pachydermia: a form of pachydermia in which the tissue of the larynx mucosa is strongly thickened, whitish and clearly wrinkled and covered with small warts
chronic edema (water retention): swelling due to fluid accumulation in the tissue (usually on the legs or ankles), e.g. in liver cirrhosis and chronic venous insufficiency
Elephantiasis: enlargement or swelling of a part of the body (e.g. legs or external genitals) due to congested lymph fluid (lymphedema), which is no longer adequately transported away via the lymphatic system.
Cancer of the lymphatic and / or blood system (e.g. non-Hodgkin lymphoma or leukemia)

What does elephant skin look like?

Similar to elephants, the skin appears keratinized, wrinkled, swollen and dry. Those affected often report itchy and painful areas of the skin. Spots on the skin are also visible in some cases. Skin thickening such as calluses occur particularly on the soles of the feet and on the palms of the hands.

How do you recognize pachydermia?

If the person concerned notices thickening of the skin that is painful or appears unusual, the family doctor is the first point of contact. If necessary and for further examinations, he will refer you to a dermatologist.

Talk to the doctor

Before the actual examination of the skin, the doctor has a detailed discussion with the person concerned (anamnesis).Among other things, he asks questions about existing skin problems and changes, for example where they first appeared, whether they occurred suddenly or have developed over a longer period of time, whether there are possible triggers for the skin thickening (e.g. shoes that are too tight), whether the person concerned has other illnesses (e.g. neurodermatitis).

Physical examination

The doctor then examines the skin for any visual abnormalities (e.g. deformations, injuries). He examines the skin closely (e.g. with a special skin magnifier or a microscope) and, if necessary, scans it. The doctor can often diagnose the disease based on the typical skin changes (so-called eye diagnosis). He also uses palpation to check the texture of the skin and the underlying tissue, how thick the lesions are and whether they are painful.

Which skin changes do you look for?

In order to describe the skin thickening as precisely as possible and to find clues as to the triggering cause, the doctor pays attention to the following:

Type of skin change: Is it a skin thickening, nodules (e.g. also with skin cancer or warts), vesicles (e.g. with neurodermatitis or shingles), dandruff (e.g. with psoriasis) or spots (e.g. with hives)?
Skin color: Is the skin reddened or yellowish or bluish in color?
Skin texture: is the skin thickened? Are nodules palpable? Is the skin rough and dry?
Differentiation from healthy skin: Are the edges of the skin thickening clearly demarcated from healthy skin? Do they look even or irregular?
Size and extent of the skin changes: Are the skin changes distributed over an area, in lines or in circles? Do they occur symmetrically on both sides or on one side?
Body part: Where on the body is the skin change located?
Additional complaints: Does the affected skin area itch, burn, hurt or bleed?

In most cases, the doctor can already tell during the physical examination whether the skin is abnormally thickened, and if so, what it is.

Scratching or inflammation usually changes the affected area of the skin. If you take pictures of the changes in the skin regularly (e.g. once a week or if you notice a change), it will be easier for the doctor to identify changes in size and shape and to make a more precise diagnosis.

Ultrasonic

If necessary, the dermatologist measures the skin density and thickness with a special ultrasound device. To do this, the doctor guides the device over the affected area of skin. The ultrasonic waves penetrate the skin and are reflected differently by the individual tissue structures. In this way, the doctor can make skin structures visible to a depth of 1 cm and assess the thickness and density of the skin.

Other investigations

If necessary, the doctor will also examine the person's blood. The blood values give, among other things, indications of inflammation, allergies or other diseases. In some cases, a skin biopsy is useful. A small skin sample is taken under local anesthesia and then examined for malignant skin tumors in the laboratory. The biopsy also provides information on possible infections, autoimmune diseases or forms of allergy.

A skin swab is also useful to detect pathogens such as fungi or bacteria. The dermatologist removes some skin cells or some secretion with a small brush, cotton swab or spatula. He then examines the sample under a microscope or has it analyzed in a laboratory.

The doctor also uses a special high-pressure mercury lamp that emits ultraviolet light (UV light) to check whether certain fungal diseases are present on the skin. These are visible through UV light.

How can you prevent elephant skin?

It is important to support the regeneration of healthy skin - regardless of possible causes or underlying diseases. There are various possibilities for prevention:

Proper care against skin thickening

To keep your skin supple and resilient, it needs moisture. In this way, the skin protects itself better against external influences, pressure and friction. For the prevention of pachydermia, it is therefore advisable, after consulting a doctor or pharmacist, to use the appropriate care creams from the pharmacy (e.g. with urea or water-in-oil emulsions).

Do without conventional skin care products from the drugstore. They often contain plasticizers, preservatives and colors, artificial fragrances or binders. These can stress, irritate and additionally dry out the skin.

Regular professional foot care also has a preventive effect against calluses.

Diet for skin thickening

Basically, make sure to support the health of your skin with proper nutrition. We recommend a balanced and varied diet with lots of vegetables, fruit, grains and fiber - and little meat and fish.

Adequate hydration (about 1.5 to 2 liters per day) is also important for the health of the skin in order to provide it with sufficient moisture. Suitable thirst quenchers are tap water and mineral water. Unsweetened tea and juice spritzers (one part juice, two parts water) are also recommended.

For the sake of your skin and health, avoid alcohol, smoking and too much sugar, salt and fat.

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