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Background: The high burden of menopausal symptoms notwithstanding, there is a paucity of published work evaluating its impact specifically on the skin and mucosa. With high incidence of underreported cases in developing countries, active screening of all women is essential for accurate assessment of prevalence of cutaneous features, as highlighted by this study. The objective of this study is to assess clinical patterns of dermatosis in menopausal women.Methods: A cross‑sectional study conducted in the dermatology department conducted on postmenopausal patients below 65 years having dermatoses after taking their written consent. Data analysis using SPSS 20.0.Results: Of 350 postmenopausal women, 165 had genital involvement, atrophic vaginitis (41.21%) being the most common manifesting typically as vaginal dryness. Of 82 women having oral complaints, 42.7% women had complaints of pain or difficulty swallowing in the absence of mucosal lesions. Of the total sample size, 34% women had had female pattern hair loss, maximum women with grade I-2 (45.4%) and I-3 (36.13%). Two key findings which we did not find previous records of included incidence of keratoderma climactericum (2.29%) and hirsutism in early menopause which we found to be 8%. It is important to note that only 28% of women were aware that their complaints were related to menopause or chose to seek active treatment for existing complaints.Conclusions: This study highlights the various clinical patterns of postmenopausal dermatoses to raise awareness in dermatologists and gynecologists for prompt diagnosis, treatment and patient education.

Menopause is defined as permanent irreversible cessation of menses brought by decline in ovarian follicular activity. Hormonal alteration results in various physical, psychological, and sexual changes in menopausal women. Associated dermatological problems can be classified as physiological changes, age-related changes, changes due to estrogen deficiency and due to hormone replacement therapy. Dermatosis seen due to estrogen deficiency includes Atrophic Vulvovaginitis, Vulvar Lichen Sclerosus, Dyaesthetic Vulvodynia, Hirsutism, Alopecia, Menopausal Flushing, Keratoderma Climactericum, Vulvovaginal Candidiasis. Dermatologists and gynecologists need to be familiar with the problems of menopausal women, as with increase in life expectancy, women passing through this phase is rising.

Palmoplantar keratodermas (PPKs) are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. Traditionally they have been classified as either hereditary or acquired and are distinguished from each other on the basis of mode of inheritance, presence of transgrediens (defined as contiguous extension of hyperkeratosis beyond the palmar and/or plantar skin), co-morbidities with other symptoms, and extent of epidermal involvement, namely diffuse, focal, and punctate. As the terms hyperkeratosis and keratoderma have been used interchangeably throughout the literature, we define acquired keratoderma as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves/=50% of the surface of involved acral areas and that may or may not be associated with clinical and histologic inflammation. Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task. To facilitate such evaluations, this review categorizes the acquired PPKs as: keratoderma climactericum, drug related, malnutrition associated, chemically induced, systemic disease related, malignancy associated, dermatoses related, infectious, and idiopathic. In order to avoid the possibility of overlooking an underlying etiology and to eliminate excessive testing, we present an algorithm for assessing patients presenting with acquired PPK. The first step should include a comprehensive history and a physical examination, including a complete skin examination. If findings are consistent with a hereditary keratoderma, then a genetics consultation should be considered. Any findings suggestive of underlying conditions should be aggressively evaluated and treated. If no pertinent findings are identified after a history and a physical examination, laboratory and radiology studies should be undertaken in a systematic, logical fashion. In terms of treatment, the most successful results occur when the underlying etiology is diagnosed and treated. If no such etiology is evident, then conservative treatment options include topical keratolytics (urea, salicylic acid, lactic acid), repeated physical debridement, topical retinoids, topical psoralen plus UVA, and topical corticosteroids. Etretinate and acitretin have also shown some success as alternative treatments in recalcitrant cases.

We report the results of an ultrastructural study of the hyperkeratotic epidermis in 23 cases of palmoplantar keratoderma (PPK) comprising 8 inherited keratoderma, 8 keratoderma climactericum in menopausal women and 7 symptomatic keratoderma. In all but one of the cases of inherited PPK and keratoderma climactericum, composite keratohyalin (KH) granules were found in granular cells of the interductal epidermis, which were similar to those found in the rat and in some other conditions. In the cases of symptomatic keratoderma, e.g. secondary to eczema, the appearance of the KH granules did not differ from that of granules observed in two normal plantar skin samples. While the real role played by these granules is unknown, they could constitute a differentiation marker of intraepidermal duct cells, and their abundance in PPK suggest that intraepidermal sweat ducts may play a part in PPK histogenesis.

10 cases of keratoderma climactericum are reported. This keratosis of the palms and soles appears late in women of menopausal age. The keratotic lesions first develop at the plantar pressure points, making walking troublesome. Involvement of the hands remains discrete. Examination for contact allergy, fungal tests, vitamin A serum levels, and sex hormones were negative or normal in all the 10 patients. Microscopy revealed a lichenified eczema with evidence of mechanical irritation. Etretinate (0.78 mg/kg/day) brought about partial or total remission of the hyperkeratosis. Pain on walking disappeared in all the patients.

Three cases of palmar and plantar hyperkeratosis were observed in young women following bilateral oophorectomy. We found this condition, previously described as keratoderma climactericum, to be completely reversible with estrogen replacement therapy. In patients with hysterectomy in addition to oophorectomy, the major risk of estrogen administration, endometrial cancer, does not apply.

Definite clinical evidence is at hand that at various periods of the life cycle hormonal disturbances play undisputed roles in diseases of the skin. This is especially true of a hormonal gonadal disturbance, which is evidenced by such conditions as tinea tonsurans during childhood, acne juvenilis during adolescence, the so-called tumor of pregnancy of the alveolar processes, keratoderma climactericum of Haxthausen, senile vaginitis and keratosis senilis of the aged. Reichert 1 stated: "It is an old story that in juvenile acne, as in senile pruritus and in eczema of old persons, hormonal disturbances play a particular role and that a great many attempts have been made to influence these diseases with endocrine treatment." It has been observed that inflammations of the skin in older men frequently behave according to a pattern all their own. It is not uncommon for even an uncomplicated and mild dermatitis to assume major proportions of

Keratoderma climactericum is apparently a rare disease in North America if one is to judge by the paucity of clinical reports. 1 The original report by Haxthausen 1a described "a distinct clinical picture consisting of circumscribed hyperkeratosis, mainly of palms and soles in women in association with the climacteric, and accompanied by various general signs and symptoms, of which obesity and hypertension are the most frequently encountered." The hyperkeratoses are discrete at the beginning and project only slightly above the level of the skin. The horny layer is often slightly frayed and sometimes crossed by fissures. There are no miliary vesicles, erythema or other evidences of eczema. There is no itching unless the eruption becomes eczematized, which is when the patient seeks medical aid. The asbestos-like layer does not permit exfoliation by grattage as with psoriasis. The dermatosis is always found in association with the menopause

A new inhibitor of cholesterol synthesis, 20,25 diazachlestenol, produced myotonia in 31 persons; and, in six of these, a keratoderma which resembles the natural disease, keratoderma climactericum. These observations further emphasize the importance of normal lipid synthesis in orderly cornification.

Although not the first to describe a peculiar keratotic thickening of the palms and soles associated with the climacteric, Haxthausen1in 1934 presented a clear description of the eruption and noted its association with other evidences of the climacteric. He applied the term keratoderma climactericum to a "distinct clinical picture consisting of circumscribed hyperkeratosis, mainly of the palms and soles, occurring in women in association with the climacteric and accompanied by various general signs and symptoms, of whichobesityandarterial hypertensionare those most frequently encountered." This disease had received little attention before Haxthausen's report and even now is not often considered. There have been a few reports of cases, but both the dermatologic textbooks and those on endocrine diseases have given it little attention. Dermatologists should be more familiar with this keratosis, first, because it is more common than is generally realized; second, because its presence indicates