Keratoderma climactericum: an under-reported condition successfully treated with an estriol cream

Climacteric keratoderma is a specific cutaneous disorder often underreported, potentially misdiagnosed, or undervalued. Although the pathogenesis remains undetermined, hormonal changes during menopause heavily affect the trophism and normal cellular function of the epidermis and dermis of the palmoplantar regions. We present the case of a 55-year-old woman referred to the Dermatological Clinic of Cagliari for acquired bilateral palmoplantar hyperkeratosis not responding to common topical treatments. Based on the medical history, clinical appearance of the lesions, and laboratory tests, keratoderma climactericum was diagnosed, as confirmed by histopathological examination. An overlap with allergic contact dermatitis was also detected through patch testing, and its synergic effect contributed to the perpetuation of the dermatosis on the hands. A daily high-potency corticosteroidal topical therapy, combined with a 50% urea-based cream at night, was only partially effective. However, adding estriol-based cream at a concentration of 0.125% led to a significant clinical improvement. Climacteric keratoderma is an acquired condition that deserves further clinical trials to assess topical hormonal treatment protocols, as the current approach is largely empirical.