Case of the Month with Crutchfield Dermatology

Wednesday, October 2, 2013

A 54-year-old woman complains of dry, cracked heels that worsen in the fall and winter. The condition has been recurrent for the past three to five years. Her mother had the same problem. The woman says her heels catch on her socks and stockings, causing tearing and bleeding. What is your diagnosis?

Diagnosis: Keratoderma Climactericum

This disorder was first described by Haxthausen in 1934. Hyperkeratosis begins over pressure points on the heels in women older than 45. There is no preceding history of skin disorders, including eczema or psoriasis. As the hyperkeratosis extends, fissures form and make walking painful. Obesity and dry winter climates aggravate the symptoms, as can wearing backless shoes, e.g. sandals. If present, involvement of the hands is much milder and more discrete. Deschamps et al. investigated 10 patients with keratoderma climactericum, measuring sex hormone levels and serum vitamin A levels, as well as performing fungal scrapings and patch tests, all of which were normal or negative. Others have reported similar changes in young women following oophorectomy. These changes responded to estrogen replacement.

In my experience, the condition is seen more frequently during the drier times of the year (fall and winter). In fact, one of my previous partners used to call this “Minnesota winter foot.” There seems to be some debate as to whether this is a true keratoderma or just an extreme case of xerosis of the foot. I see it in men and women and in people of almost all ages during winter in Minnesota. Nevertheless, I find the simple treatment program outlined below tends to work very well for management and resolution.

Treatment

Apply Eucerin Plus cream — it has to be this exact formulation of the Eucerin products; others do not work as well. I have my patients soak their feet in warm water for three to five minutes, pat dry, apply the Eucerin Plus cream liberally to their heels, and apply cotton socks for occlusion therapy overnight. I also have them apply another coat in the morning after bathing or showering. I find, for the vast majority of patients, this tends to improve or even eliminate the condition to the patient’s satisfaction in approximately one week. I like Eucerin Plus cream because the “Plus” indicates it has both ammonium lactate for extra moisturization and urea for additional moisturization and loosening of dry skin and scale.


For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit www.CrutchfieldDermatology.com.