Hyperkeratosis

Medically Reviewed by Zilpah Sheikh, MD on September 25, 2024
Written by Marijke Vroomen Durning, RN
9 min read

Hyperkeratosis is a skin condition that causes you to have thick, rough patches of the outer layer of skin. The name comes from the term for too much (hyper) of the protein keratin, which is part of the skin. You might know about some types of hyperkeratosis, such as eczema, corns, and warts, but it may appear in many more forms.

There are two types of hyperkeratosis, pressure-related and non–pressure-related. Each of have different forms of the condition.

Pressure-related hyperkeratosis

Pressure-related hyperkeratosis happens when there’s damage to the skin. This damage could be from irritation or pressure. Common examples include rubbing from footwear or tight clothing. Constant pressure and irritation can lead to inflammation and skin damage after the pain and blister or wound has healed.

Non–pressure-related hyperkeratosis

Non-pressure-related hyperkeratosis happens when your skin thickens because of a medical condition that damages the skin. This could be an autoimmune disorder or a genetic disease.

Forms of hyperkeratosis

Actinic keratosis (also called solar keratosis): This type is very common and caused by skin damage from the sun.

Corns and calluses: These common skin conditions are examples of pressure-related hyperkeratosis.

Eczema. Another common skin condition, eczema causes your skin to become dry, bumpy, and itchy.

Epidermolytic hyperkeratosis. This form is present at birth. Babies with this condition have very red skin and maybe blisters.

Hyperkeratosis of the nipple and areola. This causes thickening of the skin on the nipple and areola, which may look like warts. It most often affects teen girls. Doctors don’t know what causes it.

Keratosis pilaris (follicular hyperkeratosis). Another common condition, keratosis pilaris happens when small scaly plugs — a buildup of keratin — block your hair follicles. This causes bumpy or rough skin over the area. It commonly affects your upper arms, thighs, and buttocks. They can also appear on your face, especially among children. Researchers believe the condition is genetic.

Lichen planus. This is an autoimmune disorder. Doctors believe it is genetic.

Psoriasis. Psoriasis is another autoimmune skin disease. It causes you to have plaques on your skin. These are thick, silvery sections that can be very itchy and uncomfortable.

Retention hyperkeratosis. If you have retention hyperkeratosis, skin cells that normally shed don’t. They stay on the skin and stick together. This forms acne.

Seborrheic keratosis. These very common skin growths typically appear as people reach their 50s. Usually, they are harmless, but if they occur suddenly and quickly, they could be a sign of something more serious.

Subungual hyperkeratosis (hyperkeratosis of the nail). This is a symptom of nail psoriasis, and it leaves a chalky substance underneath your nails.

Warts. Warts occur when a virus causes your skin to thicken and form a bump.

Because there are so many types of hyperkeratosis, there are many possible causes. In some cases, doctors don’t know what causes the condition. These are the most common hyperkeratosis causes:

  • Allergies can cause hyperkeratosis such as eczema.
  • Autoimmune diseases can cause conditions such as psoriasis and lichen planus.
  • Chemicals, including tattoo ink, can cause a reaction in the skin, causing your skin to become thicker in certain spots.
  • Chemotherapy can cause damage to the outer layer of your skin.
  • Dermatitis (eczema) can develop if you have an allergy. It can also show up if your skin becomes inflamed or irritated.
  • Genetic conditions such as epidermolytic hyperkeratosis are passed from parent to child.
  • Skin infections such as the human papillomavirus (HPV) can cause warts. Because these are caused by a virus, they are also contagious. You can spread warts to others.
  • Pressure or irritation (rubbing) is what causes calluses and corns.
  • Sun exposure over your lifetime can cause skin damage, leading to actinic keratosis.
  • Vitamin A deficiency can cause phrynoderma, which is a type of hyperkeratosis affecting your hair follicles.

The symptoms of hyperkeratosis are simple, and most don’t cause any pain. However, corns and calluses could be painful because of where they are (often on your feet). Symptoms you may notice include:

  • Rough patches of skin
  • Bumps
  • Changes in skin color

What hyperkeratosis looks like depends on what form you have, where it is, and sometimes the color of your skin. Some types show up as a rash, bumps, pimples, or larger raised bumps of skin.

For light-skinned people, rashes could show as reddened areas. For darker-skinned people, the skin color may be noticeably different (darker, lighter, purple, or gray). Sometimes, there doesn’t seem to be any color difference.

Some types of hyperkeratosis, such as lichen planus, look different depending on where they are on the body. Lichen planus causes purplish, itchy, flat bumps on the skin. If you have lichen planus in your mouth or genital area, it may look like lacy white patches.

Some types of hyperkeratosis are easy to diagnose, such as warts and corns. Others require testing to not only find out what condition it is, but how far along it’s progressed.

First, your doctor will take a medical history, including information about your family’s health to see if anyone else has a form of hyperkeratosis. You’ll likely be asked about:

  • Sun exposure over your lifetime
  • Symptoms and how long you’ve had them
  • Medications and supplements you take
  • Allergies
  • Any other medical problems you have

Next, your doctor will want to do a physical exam, often not just of the area where you have symptoms. This may include examining your scalp, for example. If your doctor wants a closer look at your skin, they may use a small handheld device called a dermatoscope. 

Sometimes, doctors order a biopsy of the area where the skin is raised or thickened. If your doctor thinks you may have an allergy, you might be sent for allergy testing.

Hyperkeratosis treatment depends on what type you have. For example, calluses and corns might be filed down. Several over-the-counter (OTC) products treat some forms of hyperkeratosis, but most treatments are done by qualified health professionals. Here are some treatments and what conditions they might be used for:

Corticosteroids

You can buy some OTC steroid creams or ointments to try to treat mild hyperkeratosis. If this doesn’t work, you may need prescription-strength treatments for: 

  • Eczema
  • Lichen planus
  • Subungual hyperkeratosis

Medicated creams and patches

There are some OTC patches and gels or liquids that can treat corns. Be sure to follow the instructions carefully if you try one. Certain people shouldn’t use these products, such as those who have diabetes.

Some conditions that might be treated with medicated creams and patches (either OTC or prescription) include:

  • Actinic keratosis: Fluorouracil (Carac, Efudex), imiquimod (Aldara, Zyclara), diclofenac
  • Keratosis pilaris: Moisturizing creams
  • Psoriasis: A combination of creams including vitamin D, retinoids, and medications like tacrolimus (Protopic) and pimecrolimus (Elidel)
  • Subungual hyperkeratosis: Tazarotene, anthralin, retinoids
  • Corns and calluses, warts: OTC products
  • Epidermolytic hyperkeratosis: A combination of treatments, including creams or ointments that help soften the skin (emollients and topical keratolytics), and antibiotics to prevent infection

Oral medications

Some hyperkeratosis conditions need oral medications. These include:

Injected medications

If you need more aggressive psoriasis treatment, your doctor might recommend injections or intravenous medications. These drugs include steroids and biologics, which affect the immune system. The biologics approved in the U.S. for treating psoriasis are:

Dermatologic treatments

There are also several treatments that don’t include medications, such as:

  • Laser treatments: Keratosis pilaris, warts, eczema
  • LED light therapy: Actinic keratosis, eczema, psoriasis
  • Shave removal: Seborrheic keratosis
  • Trimming away excess skin: Corns. Some people ask for estheticians to do this, but shaving away the skin can result in cuts, which can become infected. Health care professionals, such as nurses, can do this. If you have diabetes, this should only be done by a health care professional who has training in foot care.
  • Exfoliation: Keratosis pilaris, retention hyperkeratosis
  • Chemical peels: Actinic keratosis, some types of acne
  • Cryotherapy (freezing): Actinic keratosis, seborrheic keratosis, warts

Hyperkeratosis treatment at home

Taking care of your skin is an important part of managing hyperkeratosis conditions. Here are some basic home care tips:

  • Stay hydrated.
  • Don’t peel or pick at any scaly patches or bumps.
  • Wash your skin gently and pat dry, don’t rub.
  • Avoid hot baths and showers. Use warm water.
  • Use mild soaps or soap-free cleansers.
  • If you want to remove dead skin, use a loofa or soft washcloth.
  • Moisturize your skin with an oil-free product right after bathing or showering.
  • Avoid shaving or waxing.
  • Use a humidifier if the air in your home is dry.
  • Avoid wearing tight clothes that can rub against your skin, causing friction.

For corns and calluses, you can also try:

  • Soaking the hand or foot with the callus in warm soapy water. This may soften the skin, making it easier to remove it.
  • After soaking, use a pumice stone, nail file, or wash cloth to rub the tough skin. Don’t purposely break the skin using something sharp.
  • Apply corn pads to the affected area to protect it from rubbing against your shoe.
  • Make sure your shoes are well-fitting, adding inserts if needed.

Some forms of hyperkeratosis, such as those that are genetic or autoimmune, can’t be prevented, but you might be able to reduce the number of lesions or spots. Other types, like corns and calluses, can be prevented. Here are some tips:

  • Stay out of the sun and use proper sun protection (at least SPF 30) if you are outside. This will help lower the risk for actinic keratosis.
  • Moisturize your skin, avoid harsh chemicals and soaps, and keep the air from getting too dry using a humidifier to reduce eczema breakouts.
  • Avoid allergens, such as pets or pollen, if your skin reacts to them.
  • Always wear something on your feet when in public areas, such as gyms or locker rooms, to avoid the virus that causes warts.
  • If you use a pumice stone or emery board on a wart, do not use it on another part of your body, including your nails.
  • Don’t share hot tubs or warm baths to prevent spreading warts.
  • If you take prescription medication to manage your condition, take it as directed, and don’t stop unless your doctor advises you to.

Whether hyperkeratosis goes away depends on what type you have. For example, warts, corns, and calluses can go away with proper treatment and never return for some people, but they might for others.

  • Actinic keratosis: This can get worse with age. Exposure to the sun can eventually cause squamous cell carcinoma if it’s not treated.
  • Psoriasis: It isn't curable but can be controlled with treatment.
  • Eczema: Some children outgrow eczema. Adults can often manage eczema with treatment, but it doesn’t go away.
  • Epidermolytic hyperkeratosis: There is no cure and the disease is progressive, so it doesn’t go away.
  • Keratosis pilaris: It usually goes away with treatment.
  • Lichen planus: With treatment, lichen planus on your skin can go away within a few months, but sometimes it could take a few years.
  • Seborrheic keratosis: Lesions may continue to show up, but they rarely go away.

Some forms of hyperkeratosis are quite common, such as corns, calluses, and warts. These kinds are caused by rubbing, irritation, or even a virus. Other types of hyperkeratosis are rarer, such as epidermolytic hyperkeratosis, which is genetic — you’re born with it. Some forms are autoimmune, such as psoriasis. Before trying to treat hyperkeratosis on your own, it’s best to check with your health care provider to get a diagnosis. Then, you can discuss if any OTC products are a good idea, or if you need medical treatment.

What vitamin deficiency causes hyperkeratosis?

If you don’t have enough vitamin A, you could develop phrynoderma, a type of follicular hyperkeratosis.

Can hyperkeratosis become cancerous?

One type of hyperkeratosis, actinic keratosis, can become cancerous if left untreated. It can eventually cause squamous cell carcinoma.

Is hyperkeratosis a wart?

A wart is a form of hyperkeratosis.

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