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What is pachydermia?

by Josephine Andrews
Published: Last Updated on 461 views

Pachydermia or pachyderma (colloquially also elephant skin) is what doctors call thickened and/or hardened skin or mucous membranes. Depending on the trigger, this is treated with medication, creams and rarely surgically. Skin thickening can develop as a result of repeated inflammation of the skin, for example as a result of diseases such as neurodermatitis. Read here how to prevent skin thickening and what helps against it!

quick overview

  • What is pachydermia? thickened, hardened skin or mucous membrane
  • Treatment: The treatment depends on the cause of the skin thickening. Creams, tinctures, ointments and medicines are used.
  • Causes: Enlarged skin cells caused by skin irritation (e.g. friction or pressure) and/or diseases (e.g. neurodermatitis ).
  • Diagnosis: discussion with the doctor, physical examination (possibly measurement of skin density)
  • Prevention: skin care with special creams and ointments (water-oil emulsions), balanced diet

What is pachydermia?

Pachydermia is the technical term for excessively thickened and/or hardened skin or mucous membranes. It is colloquially called elephant skin. Skin thickening usually develops as a result of recurring inflammation of the skin. These occur with certain diseases such as psoriasis or neurodermatitis.

Skin thickening or hardening can also occur if those affected put excessive strain on the skin in a specific area. The skin thickens to protect the underlying tissue (called the callus).

A special form of skin thickening is pachydermia of the vocal folds, which is also a precursor to vocal fold cancer. The mucous membrane and glandular tissue (squamous epithelium) that cover the surface of the vocal folds thicken.

What helps against elephant skin?

After the doctor has found the cause of the thickening of the skin, he decides together with the person concerned about the further treatment steps. These depend on the trigger of the skin thickening.

treat underlying disease

If the person concerned suffers from neurodermatitis and this is responsible for the thickening of the skin, the doctor treats the underlying disease. For this he prescribes, for example, moisturizing and moisturizing skin creams that relieve the itching .

Drugs such as cortisone are also used specifically for neurodermatitis and other inflammatory diseases. These inhibit pro-inflammatory messenger substances in the body and thus alleviate the symptoms that occur.

Avoid skin irritation

If the thickening of the skin is the result of external skin irritation (e.g. pressure or friction), dermatologists recommend avoiding the triggering irritation. Therefore, if you have calluses on your feet, for example, make sure not to wear shoes that are too tight.

skin care

Proper care is also important for skin thickening. The most important thing is to provide the skin with sufficient moisture.

creams and ointments

Cream your skin with special skin creams and ointments. Depending on the condition of the skin, dermatologists recommend either highly moisturizing and/or fatty products. Water-in-oil emulsions (W/O emulsions), for example, provide the skin with sufficient moisture and keep it supple. This strengthens the natural protective barrier, making it more resilient and less sensitive to external influences.

Care creams with urea (urea) are also suitable. The urea it contains binds moisture in the upper layers of the skin and protects the skin from drying out.

remove calluses

The skin forms calluses as a natural protective reaction to friction or pressure (e.g. from shoes that are too tight). In principle, calluses do not have to be removed. If you find the excessive calluses, for example on your feet, annoying, it is possible to remove them.

Calluses can be carefully removed with appropriate aids such as pumice stones, callus files and callus rasps. Before treatment with files and planes, doctors recommend a foot bath to soften the calluses. This makes it easier to solve. A nourishing scrub helps to remove excess skin cells and smooth the skin’s surface.

In order to avoid possible injuries when removing stubborn calluses, doctors recommend professional (medical) foot care (eg from a podiatrist).

Callus-dissolving formulations from the pharmacy that contain salicylic acid and urea are also suitable for removing calluses. They penetrate the skin and facilitate the detachment of the outer layers of skin cells. The skin flakes faster and is stimulated to renew itself at the same time. Urea also reduces the growth of microorganisms on the skin (e.g. fungi, bacteria ) and binds water in the horny layer. This makes the skin smoother and more supple.

Salicylic acid also has an antibacterial and anti-inflammatory effect. Skin irritation can heal faster. Drugs with salicylic acid and urea are available in pharmacies in both liquid (e.g. solution, tincture) and semi-solid (e.g. cream, gel, ointment) dosage forms.

Ask your doctor or pharmacist which products and care products are best suited for your skin and how to dose them.


In some cases, the thickened cornea is a sign of chronic inflammation of the skin (dermatitis). It is scarred and calluses (tylom) form. If those affected are in pain (e.g. with a corn ) or if they find the skin change to be extremely disturbing, the doctor can also surgically remove the thickening of the skin. To do this, the affected person first takes a foot bath with warm water to soften the cornea. The doctor then carefully removes the superfluous layers of the cornea using a suitable instrument (e.g. milling machine or scalpel).

Correct foot misalignments

If the callus forms as a result of pressure points as a result of a foot malposition (e.g. flat or splayfoot), those affected can relieve this by wearing wide-cut and comfortable shoes. In addition, insoles and special training of the foot muscles can help to correct the misalignment and thus take the pressure off the stressed skin.

If that doesn’t help, an operation is also possible or necessary to correct the foot deformity. For the doctor, symptoms such as persistent pain, inflammation in the toe joints and/or a disturbed gait pattern are decisive for an operation. If the foot deformity is corrected, calluses and calluses will also recede.

Is pachydermia curable?

Skin thickening is basically curable. If those affected avoid the underlying trigger and the doctor treats the affected skin area correctly, the thickened skin can also be removed. In many cases, it is possible for those affected to successfully treat the thickening of the skin themselves at home.

How is elephant skin made?

In pachydermia, the outer cell layer of the skin ( epidermis or epidermis) is stimulated to enlarge (so-called hypertrophy). The most common causes of this are certain diseases and long-term irritation of the skin.

Reduced sebum production (sebostasis)

If the sebaceous glands do not secrete enough sebum, the skin loses water and thickens. In more than 80 percent of cases, sebostasis is age-related, since sebum production naturally decreases with age. In some cases, changes in the hormonal balance during menopause are responsible for the fact that the skin produces less sebum and thus becomes dry.

Other causes of sebostasis are: vitamin deficiency (e.g. vitamin C , E and A), dehydration, external influences such as excessive UV radiation from sunbathing for too long, air polluted with dust and exhaust gases, synthetic cosmetic products (e.g. with substances such as polyethylene glycol, parabens , paraffins, silicones, artificial fragrances, emulsifiers).

Chronic skin diseases

Thickening of the skin (so-called lichenification) also occurs as a symptom of chronic skin diseases such as neurodermatitis (atopic eczema) or psoriasis (psoriasis) . As a result of the disease, the skin becomes calloused and thickened. This often makes her look leathery.

The skin is often thicker and less elastic, especially in the area of ​​the wrists, elbows and knees. In the case of a contact allergy , in which eczema develops as a result of contact with certain substances (e.g. metals, cleaning agents, latex), the skin sometimes thickens.

Long-term stress on the skin

If the skin is permanently stressed at a certain point, it reacts with a so-called hyperkeratosis. Healthy skin cells die off and turn into dead horny cells. The skin thickens and calluses (also called tylomas, calluses or skin calluses) develop. It protects the skin from external influences such as friction or pressure and often occurs on the foot (balls and heels).

Calluses can also develop on the hands and (with appropriate stress) in other parts of the body. It usually forms where the skin is exposed to friction and pressure for a long time. The most well-known form of tyloma is the so-called corn on the foot. It occurs, for example, when shoes that are too tight permanently strain the skin.

In most cases, calluses are harmless and easily treatable. In the event of pain or significant skin changes, however, it is advisable to consult a doctor!

symptom of other diseases

Areal thickening or swelling of the skin also occurs as a symptom of other diseases. These include, for example:

  • Cutis verticis gyrata: Rare congenital condition in which the scalp is malformed and wrinkles develop
  • Pachydermoperiostosis: Rare, inherited condition that causes the skin to thicken and wrinkle, among other things
  • Lichen myxoedematosus and scleromyxedema: rare skin disease in which lichen-like nodules (poplars) develop on the skin and the skin thickens and hardens over a large area
  • Erythropoietic protoporphyria: rare metabolic disorder; the skin itches, burns and reddens from exposure to the sun; the skin thickens
  • Interarytic(a)enoid pachydermia: a form of pachydermia in which the tissue of the lining of the larynx is very thick, whitish and clearly wrinkled, and covered with small warts
  • Chronic edema (water retention): Swelling due to fluid accumulation in the tissue (usually in the legs or ankles), e.g. in cirrhosis of the liver and chronic venous insufficiency
  • Elephantiasis: Enlargement or swelling of a body part (e.g. legs or external genitals) due to accumulated lymphatic fluid ( lymphedema ) that is no longer sufficiently transported away via the lymphatic system.
  • Cancers of the lymphatic and/or blood system (e.g. non-Hodgkin’s lymphoma or leukemia )

What does elephant skin look like?

Similar to elephants, the skin appears calloused, wrinkled, swollen and dry. Those affected often report itchy and painful skin areas. Spots on the skin are also visible in some cases. Thickening of the skin such as calluses occurs particularly on the soles of the feet and on the palms of the hands.

How do you recognize pachydermia?

If the affected person notices thickening of the skin that is painful or unusual, the family doctor is the first point of contact. He will refer you to a skin doctor (dermatologist) if necessary and for further examinations.

conversation with the doctor

Before the actual examination of the skin, the doctor conducts a detailed discussion with the person concerned ( anamnesis ). Among other things, he asks questions about existing skin problems and changes, for example where they first appeared, whether they appeared suddenly or developed over a longer period of time, whether there are possible triggers for the skin thickening (e.g. shoes that are too tight), whether the person concerned has other diseases (e.g. neurodermatitis).

Physical examination

The doctor then examines the skin for visual abnormalities (e.g. deformations, injuries). He examines the skin closely (e.g. with a special skin magnifying glass or a microscope) and feels it if necessary. The doctor can often diagnose the disease based on the typical skin changes (so-called visual diagnosis). In addition, he uses palpation to check the condition of the skin and the underlying tissue, how thick the skin changes are and whether they hurt.

What skin changes do you look for?

In order to describe the thickening of the skin as precisely as possible and to find clues to the triggering cause, the doctor pays attention to the following:

  • Type of skin change: Is it a thickening of the skin, nodules (e.g. also in skin cancer or warts), blisters (e.g. in neurodermatitis or shingles ), dandruff (e.g. in psoriasis) or spots (e.g. in hives )?
  • Skin color: Is the skin red or yellowish or bluish?
  • Skin condition: Is the skin thickened? Are nodules palpable? Is the skin rough and dry?
  • Demarcation from healthy skin: Are the edges of the skin thickening clearly demarcated from healthy skin? Do they look even or irregular?
  • Size and spread of the skin change: Are the skin changes distributed over an area, in a line or in a circle? Do they occur symmetrically on both sides or on one side?
  • Body part: where on the body is the skin change?
  • Additional symptoms: Does the affected area of ​​skin itch, burn, hurt or bleed?

In most cases, the doctor already recognizes during the physical examination whether it is a pathological thickening of the skin, and if so, which.

The affected area of ​​skin usually changes as a result of scratching or inflammation. If you photograph the lesion regularly (for example, once a week or whenever you notice a change), it is easier for the doctor to recognize changes in size and shape and to make a more accurate diagnosis.


If necessary, the dermatologist will measure the skin density and thickness with a special ultrasound device. To do this, the doctor guides the device over the affected area of ​​skin. The ultrasonic waves penetrate the skin and are reflected differently by the individual tissue structures. In this way, the doctor can visualize skin structures up to a depth of 1 cm and assess skin thickness and skin density.

Other investigations

The doctor will also examine the patient’s blood if necessary . The blood values ​​give indications of inflammation, allergies or other diseases, among other things. In some cases, a skin biopsy is useful. A small skin sample is taken under local anesthesia and then examined in the laboratory for malignant skin tumors. The biopsy also provides information about possible infections, autoimmune diseases or forms of allergies.

A skin swab is also useful to detect pathogens such as fungi or bacteria. The dermatologist uses a small brush, a cotton swab or a spatula to remove some skin cells or some secretion. He then examines the sample under a microscope or has it analyzed in a laboratory.

The doctor also uses a special high-pressure mercury lamp that emits ultraviolet light ( UV light ) to check whether certain fungal diseases are present on the skin. These become visible with UV light.

How to prevent elephant skin?

It is important to support the regeneration of healthy skin – regardless of possible causes or triggering underlying diseases. There are a number of ways to prevent this:

Proper care against skin thickening

In order for your skin to remain supple and resilient, it needs moisture. This protects the skin better from external influences, pressure and friction. To prevent pachydermia, it is therefore advisable to use the appropriate care creams from the pharmacy (e.g. with urea or water-in-oil emulsions) after consulting a doctor or pharmacist.

Avoid conventional skin care products from the drugstore. They often contain plasticizers, preservatives and dyes, artificial fragrances or binding agents. These can stress and irritate the skin and also dry it out.

Regular professional foot care also has a preventive effect against calluses.

Diet for skin thickening

Always make sure to support the health of your skin with the right diet. We recommend a balanced and varied diet with lots of vegetables, fruit, grains and fiber – and little meat and fish.

Adequate hydration (approx. 1.5 to 2 liters per day) is also important for the health of the skin in order to provide it with sufficient moisture. Suitable thirst quenchers are tap water and mineral water. Unsweetened tea and juice spritzers (one part juice, two parts water) are also recommended.

For the sake of your skin and health, also avoid alcohol, smoking and too much sugar, salt and fat .

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