cholecalciferol and Hand-Dermatoses

The palmoplantar keratodermas (PPKs) are a heterogeneous group of disorders of cornification affecting the palms and soles. Of late, a number of rare, recessive PPKs such as odonto-onycho-dermal dysplasia have been elucidated. Surprisingly, these results indicate that correct palmoplantar keratinization depends on intact Wingless (WNT) signalling. WNT was originally discovered in the fruit fly where it is required for wing morphogenesis. This ancient signalling pathway is now emerging as a master regulator of differentiation in a variety of tissues, including the intestine and the hair follicle. It is also becoming increasingly clear that deregulation of WNT signalling is involved in neoplasia. Thus, a single pathway unites several seemingly disparate processes and disorders. The keratodermas are emerging as model systems in which to study WNT signalling. Moreover, as agents that are in the dermatological arsenal can modulate WNT signalling, some insight into its workings is of importance to the practicing dermatologist. In this review, I outline how WNT signalling is involved in epidermal differentiation and skin cancer and what these new insights mean for everyday dermatology.

Topics: Cholecalciferol; Forecasting; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Nail Diseases; Skin Neoplasms; Wnt Proteins

The treatment of hyperkeratotic palmoplantar eczema is notoriously difficult. A considerable number of patients do not or only partially respond to the current treatments such as topical corticosteroids, topical keratolytics, or PUVA therapy. The purpose of this pilot study was to look for an alternative treatment for hyperkeratotic palmoplantar eczema. We treated five patients with topical vitamin D3 derivatives (calcipotriol 50 microg/g and maxacalcitol 25 microg/g ointments). The lesions almost disappeared after 2 to 8 weeks of treatment in four patients and extremely improved with a seven week treatment in one patient. No adverse effect was observed during or after the treatment, and routine laboratory investigations were within normal ranges. When relapses occurred, they responded well to retreatment. Although the study is preliminary, the results suggest that vitamin D3 derivatives offer a safe, effective alternative form of treatment for recalcitrant hyperkeratotic palmoplantar eczema.

Topics: Administration, Topical; Aged; Biopsy, Needle; Cholecalciferol; Eczema; Female; Follow-Up Studies; Hand Dermatoses; Humans; Immunohistochemistry; Keratosis; Middle Aged; Psoriasis; Risk Assessment; Sampling Studies; Severity of Illness Index; Treatment Outcome

Topics: Administration, Topical; Adult; Antiviral Agents; Cholecalciferol; Female; Hand Dermatoses; Humans; Immunocompromised Host; Male; Middle Aged; Warts