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Keratoderma Blennorrhagicum

Keratoderma Blennorrhagicum is a manifestation on the skin that appears in patients diagnosed with reactive arthritis (this condition was previously known as Reiter syndrome). The condition manifests itself by lesions that appear on the skin, initially on the palm of the hands and soles of the feet. The lesions have the tendency to spread, affecting other parts of the body, such as the scrotum, scalp or trunk. Because of their appearance, the lesions might be easily confused with the ones from psoriasis. Keratoderma blennorrhagicum is one of the symptoms that can be used for the clinical diagnosis of reactive arthritis.

Symptoms of Keratoderma Blennorrhagicum

These are the most common symptoms of keratoderma blennorrhagicum:

Lesions in the form of pustules or vesicles appear on the skin
Lesions have a waxy texture
The color of the lesions can range from yellow to brown
The lesions can join together, leading to the appearance of patches or plaques on the skin
When lesions are clustered, the patches or plaques are scaly or crusted
Desquamating edge surrounds the lesions
The large patches can appear on the face as well, being red and scaly
Sometimes the lesions can take the form of nodules, that are hard and tender to the touch
Lesions appear initially on the palm of the hands and soles of the feet, extending to other parts of the body
Lesions can be painful and uncomfortable
The vesicles or blisters are filled with pus
It can also affect the hand or toe fingers along with the nails
The patient might also suffer from mouth ulcers, affecting the entire oral cavity (tongue, lips, gums, mouth roof, soft palate)
Characteristic lesion – rash on the head of the penis
The lesions are more often encountered in the genito-urinary reactive arthritis than in the gastro-intestinal variant

Causes of Keratoderma Blennorrhagicum

The exact cause that leads to the appearance of the Reiter syndrome has yet to be identified but it seems there is a genetic predisposition. Keratoderma blennorrhagicum appears, as it was already mentioned, in the genito-urinary variant of the Reiter syndrome or reactive arthritis. This variant is caused by a urethral infection (most commonly with Chlamydia trachomatis), transmitted from one person to the other through sexual contact. The lesions on the skin are actually a reaction of the body to the infection with Chlamydia, hence the name reactive arthritis. Keratoderma blennorrhagicum remains a primary symptom of diagnosis, along with the other manifestations of the condition.

Diagnosis

Keratoderma blennorrhagicum is often diagnosed within the complete diagnosis of reactive arthritis. The clinical examination is very important, as it allows for the observation of the skin lesions and other modifications. As keratoderma blennorrhagicum appears in the genito-urinary variant of the Reiter syndrome, the doctor might check if there is any abnormal discharge from the urethra (sign of infection). A complete blood count might also detect genetic markers and signs of inflammation in the body. X-rays might be recommended in advanced stages and not for the confirmation of the diagnosis. The clinical examination remains the most important method to confirm the diagnosis.

Treatment

Reiter syndrome cannot be cured but its symptoms, including keratoderma blennorrhagicum, can be treated with success. If the patient is in the active phase of the disease, antibiotics are going to represent the primary course of treatment for keratoderma blennorrhagicum. This is because the infection caused in the urethral tract has to be properly treated for the other symptoms to subside. Anti-inflammatory medication might also be prescribed to reduce the upsetting symptoms, such as inflammation and pain. The lesions on the skin can benefit from the same treatments as the ones for psoriasis, including topical corticosteroids and other creams.