Folded pachyderma of the scalp and vocal cords

Doctors do not often diagnose pachydermia – it is a relatively uncommon disease, which is the appearance of epidermal layers on the skin and mucous tissues. The disease is characterized by uncontrolled growth and division of pathologically altered cellular structures.

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Epidemiology

According to statistics, pachydermia affects men more often, approximately in a ratio of 8:1. The disease is registered relatively rarely. The incidence rate increases after 50 years.

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Causes pachyderms

Pachydermia can be classified as congenital or acquired, depending on the underlying cause of the disease.

Congenital pachydermia may be a consequence of:

• various intrauterine anomalies of the vascular system;
• damage to the central nervous system;
• endocrine disorders.

In many cases, the cause of congenital pachydermia cannot be determined; in such cases, they speak of an idiopathic form of the disease.

Acquired pachydermia is more common and can be caused by a number of reasons:

• diseases of the skin and mucous membranes;
• systemic lupus erythematosus;
• tuberculous changes;
• thrombophlebitis and other vascular diseases.

Certain risk factors for the development of pachydermia also play a significant role:

• smoking, especially regular and frequent;
• alcohol abuse;
• chronic intoxication, work in hazardous industries, in dusty or gas-polluted areas;
• ignoring hygiene rules;
• genetic predisposition;
• old age;
• eczema, psoriasis.

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Pathogenesis

The blood and lymph circulation systems play a primary role in the processes of metabolism and trophism in tissues. However, normal tissue supply and cell purification from waste products can be carried out qualitatively only if the blood or lymph flow is free. Otherwise, problems with metabolism and tissue nutrition may arise, which may cause the development of pachydermia.

In general, the pathogenesis of the appearance of such a disease as pachydermia has not been studied enough. However, it is assumed that the basis of the pathogenetic chain is the imbalance and insufficiency of blood flow and lymph circulation. As a result, stagnation or edema may occur, followed by fibrosis of the dermis, subcutaneous fat, fascia, etc.

The listed processes lead to diffuse proliferation of the skin or mucous membranes, depending on the location of the disease.

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Symptoms pachyderms

The symptoms of pachydermia appear gradually, and it may take several years before the lesion becomes noticeable.

The first signs may be expressed in the defeat of the limbs or individual organs. At first, swelling of the skin appears, which may disappear periodically. However, such swelling differs from cardiac or renal - first of all, in that it is denser, and after pressing with the pad of the finger, no trace remains on it.

Over time, the swelling increases and becomes permanent. Soft tissues become denser and even harder.

Often, wart-like or papilloma-like growths appear on the skin. Distinct folds form between the growths. The skin thickens and tightens, and the ability to fold the skin into a fold is lost. Hyperpigmentation is sometimes observed, and erysipelas periodically reoccurs.

At advanced stages of pachydermia development, eczematous and ulcerative lesions may appear. At the same time, motor activity does not suffer, there are no changes in the musculoskeletal system with pachydermia.

The typicality of the clinical picture may also depend on the localization of the pathological process of pachydermia.

• Folded pachydermia of the head is characterized by hypertrophy of the dermis and epidermis on the scalp, in the occipital and crown areas, simultaneously with persistent expansion of the lymphatic vessels and lymphostasis. Externally, one can observe the appearance of prominent tubercles, folds: the overall picture visually resembles brain convolutions. The hair in the fold area is thickened and dense.

• Pachydermia of the larynx can occur as an independent disease or in combination with damage to other organs. The first signs of pachydermia are expressed in the appearance of tubercles of different sizes in the larynx, the color of which ranges from yellowish to pink or gray. The mucous membrane of the larynx becomes loose and bluish in appearance. The following additional symptoms may be observed:
  • difficulty swallowing;
  • attacks of dry cough;
  • hoarseness of the voice, up to and including complete loss of voice;
  • itching and sore throat;
  • signs of general intoxication (loss of appetite, feeling of fatigue, drowsiness).

• Pachydermia of the interarytenoid region of the larynx is accompanied by thickening of the mucous membrane, the appearance of epidermal limited growths (tubercles) and granulation in the area of the vocal folds and interarytenoid space. A small amount of viscous mass (secretions) and crusts can be found in the laryngeal cavity.

Stages

Taking into account the clinical picture of pachydermia, it is customary to distinguish several stages of the disease development:

• soft stage, which is accompanied by periodic swelling and a pasty consistency of tissues;
• the mixed (intermediate) stage is characterized by the spread of edema, which becomes permanent; the skin becomes thick and pale, while there is no pain;
• the stage of compaction in pachydermia occurs with thickening of the skin in the form of foci or cushions, the appearance of ulcers, warts, hyperkeratosis, hyperpigmented areas, cracks.

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Complications and consequences

Possible complications of pachydermia may include:

• development of thrombophlebitis;
• generalized dermatitis;
• addition of purulent infection, sepsis;
• malignancy of areas with pachydermia;
• disorders of the heart and blood vessels, kidneys, changes in the blood picture (due to constant protein deficiency);
• psychoneurological disorders.

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How long does it take for pachydermia to develop into cancer?

Pachydermia is an optional precancerous condition. This means that a patient with pachydermia has a high risk of developing a malignant tumor. However, one cannot think that every case of pachydermia must necessarily degenerate into a cancerous process. Moreover, it is impossible to predict when exactly this may happen.

Given that the disease is prone to malignancy, patients need to be careful, seek medical help in a timely manner and regularly undergo treatment for pachydermia.

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Diagnostics pachyderms

Diagnosis is primarily based on questioning and examination of the patient. Additional studies may also be needed to establish an accurate diagnosis of pachydermia.

• Blood tests for pachydermia:
  • serological examination of blood serum indicating the presence of antibodies to the waste products of parasites;
  • A general blood test may indicate an increase in eosinophil levels, a decrease in albumin levels, and an increase in blood clotting.
• Instrumental diagnostics:
  • Magnetic resonance angiography shows the condition of the vessels;
  • Doppler examination of blood vessels allows us to detect vascular obstruction, the presence of dilated and narrowed areas, and damage to the valve system;
  • X-rays help to track changes in the skeletal system (thickening, osteoporosis, calcifications);
  • thermography indicates a decrease in temperature in the areas of the body affected by pachydermia, or an increase in temperature in areas of inflammation;
  • Magnetic resonance imaging allows one to examine layer by layer the structure of organs and body parts affected by pachydermia.

Differential diagnosis

Differential diagnostics are carried out with the following diseases:

• lymphangioma – benign proliferation of lymphatic vessels (often present from birth);
• limited scleroderma - tissue compaction and atrophy of the epidermal layer;
• congenital form of elephantiasis - a variant of hypertrophy of the lower limbs.

It is also sometimes necessary to differentiate pachydermia from vascular insufficiency, malignant tumors, and endocrine diseases.

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Treatment pachyderms

Treatment of pachydermia is prescribed only after the malignant origin of the disease is completely rejected. Any physical procedures and even some medications can accelerate the development of the pachydermia process if it has an oncological nature.

In case of laryngeal pachydermia, it is recommended to observe the so-called "vocal rest", and one should neither pronounce anything out loud nor whisper. Gargling does not bring any noticeable effect in this disease. Inhalations are successfully used instead:

• herbal inhalations with infusions of chamomile and sage;
• inhalations with alkaline waters;
• dioxidin, miramistin;
• sofradex.

Steam inhalations are completely excluded in case of pachydermia.

In hospital conditions, it is possible to use intralaryngeal lavage with collargol, 1% dioxidine, sofradex (except for children under 18 years of age and pregnant women).

Medicines for external lesions of the extremities and parts of the body are prescribed taking into account the underlying cause of pachydermia.

	Method of administration and dosage	Side effects	Special instructions
Troxerutin	1 capsule up to 3 times a day for several weeks.	Bowel disorder, headache, allergies.	An angioprotector that strengthens blood vessels and reduces swelling.
Detralex	1 tablet twice a day with food for a month.	Nausea, diarrhea, dizziness, rash.	Angioprotector that improves blood microcirculation.
Aloe extract	Subcutaneously, one ampoule daily.	Rare: pain at the injection site.	A biological stimulant that softens dense connective tissue and promotes its resorption.
Lidaza	Subcutaneously or intramuscularly in the amount of 64 E in novocaine, daily or every other day, in a course of 20 injections.	Rare: allergic rashes.	An enzymatic active preparation that dissolves connective tissue fibers that cause thickening of the subcutaneous tissue.
Ketotifen	1 tablet twice daily.	Pain and dryness in the eyes, thirst, dizziness.	An antihistamine that reduces the manifestations of allergies and tissue growth.

It is very important to take vitamins: retinol acetate, tocopherol, B vitamins, and fish oil. Such preparations help improve tissue nutrition and prevent the growth of connective tissue fibers.

Vitamins B Neurovitan	Take 1 to 4 tablets daily, immediately after meals.
Vitamin C	Take 0.05 to 0.1 g three times a day.

Physiotherapy treatment

Physiotherapy for pachydermia can be prescribed only when the benign nature of the disease is established. For pachydermia, the following is usually prescribed:

• Electrophoresis with enzyme preparations (for example, lidase) – eliminates congestion and improves blood and lymph circulation.
• Magnetic therapy (Cascade device) – helps to cope with swelling and inflammation.
• Phonophoresis with caripain, longidase, streptokinase – promotes the dissolution of fibrin fibers and inhibits tissue compaction processes.
• Laser therapy – accelerates intravascular circulation, eliminates swelling.
• Amplipulse therapy – helps improve tissue trophism.

Additionally, balneotherapy (sulphide and carbon dioxide baths) and hydrotherapy are indicated.

Folk remedies

When diagnosed with pachydermia, the patient is prescribed medication. Folk remedies can also be used to speed up tissue recovery and general maintenance of the body.

• The affected skin is treated with milk thistle oil in the morning and at night, which successfully eliminates inflammation and disinfects.
• Instead of regular tea, it is recommended to drink rosehip infusion or cranberry compote during the day.
• Raw clay is mixed with water until it becomes doughy, a cake is formed, which is applied to the affected skin, fixed and held on the body all night. This procedure is repeated daily until a lasting effect is achieved.
• At night, make compresses from fresh birch, mint or lilac leaves.
• Instead of coffee in the morning, it is recommended to drink a chicory drink with the addition of dry or fresh ginger root.

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Herbal treatment

• Brew 30 g of dried hazel leaves in 500 ml of boiling water, leave for up to 2 hours. Take 100 ml 4 times a day, daily.
• To make lingonberry tea, brew 1 tbsp. of leaves in 250 ml of boiling water, leave for 1 hour and drink. You can add a little honey to the drink.
• Prepare a mixture of 20 g of dried chestnuts, the same amount of birch and oak bark, 30 g of astragalus and immortelle. Two spoons of the mixture are poured with 500 ml of boiling water, infused in a thermos for at least 2 hours. Filter and take 100 ml 4 times a day.
• Mix crushed garlic with honey in equal proportions, place in a glass container and keep in a cool place for one week. After that, the medicine can be taken 1 tbsp. an hour before main meals. The course of treatment is at least 2 months.

Homeopathy

• Acidum nitricum in 12C dilution, 3 granules before bedtime.
• Petroleum 6C 3 granules sublingually every morning half an hour before meals.
• Sulfur 6C 5 granules at night, for a long time.
• Teucrium marum 6C 5 granules sublingually in the morning before meals and at night.
• Apis 6C 7 granules in the morning and 3 granules at night.
• Medusa 6C, 5 granules in the morning and at night.

Homeopathic medicines are taken for a long period of time – several months, until stable positive results are achieved. If undesirable signs appear in the form of a deterioration in the condition, then the possibility of replacing the medicinal product should be discussed with a homeopathic doctor.

Surgical treatment

Surgery can significantly improve the condition of a patient with pachydermia, as well as stop the progression of the pathological process. Indications for surgery are:

• increasing fluid retention in tissues;
• rapid tissue proliferation;
• formation of pockets and bumps;
• unbearable painful sensations.

Contraindications to surgical treatment may include:

• decompensated conditions;
• old age;
• diseases of the hematopoietic system, dramatic changes in the blood picture.

The operation is performed using various techniques, depending on the nature of the lesion and its localization. Thus, the main methods of surgical intervention for pachydermia are considered to be:

• prompt restoration of normal blood and lymph flow;
• laying vascular anastomoses to ensure normal tissue nutrition;
• excision of overgrown tissue, subcutaneous fat and fascia.

The development of pachydermia can be stopped if all possible procedures are carried out as early as possible, when the disease reveals itself in its first stage.

Prevention

The main measure for preventing pachydermia is considered to be timely and correct treatment of any diseases and conditions that may cause the development of the disease.

It is recommended to follow certain rules:

• drink an adequate daily amount of fluid;
• avoid overload;
• if necessary, take medications to improve blood circulation;
• abstain from drinking alcohol;
• eat quality and varied food;
• Visit your doctor regularly for preventive examinations.

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Forecast

Pachydermia has a relatively favorable life prognosis. If drug therapy was carried out at the initial stage of the pathological process, then it is often possible to stop the progression of the disease. Surgical treatment gives a positive result in 80-90% of cases.

However, pachydermia cannot be completely eliminated.

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