What vitamin deficiency causes plantar keratoderma? Understanding the role of Vitamin A and zinc

January 5, 2026 •

4 min read

Research confirms that while many cases are hereditary, some instances of acquired plantar keratoderma have been linked to nutritional shortfalls. This article explores what vitamin deficiency causes plantar keratoderma and other potential triggers for this condition of thickened skin on the hands and feet.

Quick Summary

Acquired plantar keratoderma, characterized by thickened skin on the palms and soles, can result from nutritional deficiencies. Key deficiencies linked to this condition include Vitamin A, zinc, and thiamine, often occurring alongside general malnutrition.

Key Points

Vitamin A is a primary suspect: A deficiency in Vitamin A is a significant nutritional cause of acquired plantar keratoderma, leading to abnormal skin cell development.
Zinc deficiency is also implicated: Severe zinc deficiency, such as in acrodermatitis enteropathica, can cause a rash that affects the hands and feet and can mimic keratoderma.
Malnutrition is a common trigger: Many cases of acquired keratoderma are linked to general malnutrition and multiple vitamin deficits, not just a single one.
Hereditary vs. acquired distinction: It is vital to distinguish between genetic forms of keratoderma and acquired forms caused by external factors like nutritional status.
Correction targets the root cause: For acquired cases, correcting the underlying nutritional deficiency is a key part of the treatment, alongside topical care.
Thiamine can be a factor: Thiamine (vitamin B1) deficiency has also been reported in association with malnutrition-related plantar keratoderma.
Comprehensive assessment is needed: Given the multiple potential nutritional and non-nutritional causes, a thorough medical evaluation is necessary for accurate diagnosis.

The Connection Between Nutrition and Skin Health

Proper nutritional intake is crucial for maintaining skin integrity, cell growth, and barrier function. While many skin conditions have genetic or inflammatory origins, dermatological research has documented instances where severe malnutrition and specific vitamin deficiencies directly contribute to acquired skin diseases, including plantar keratoderma. In these cases, correcting the underlying nutritional issue is a primary step toward treatment and recovery.

The Impact of Vitamin A Deficiency

Vitamin A, an essential fat-soluble micronutrient, plays a critical role in promoting healthy skin cell growth and differentiation. A deficiency, also known as hypovitaminosis A, disrupts the normal life cycle of epithelial cells, including those found in the skin. This disruption can manifest as follicular hyperkeratosis, where keratin blocks the hair follicles, and a generalized thickening and scaling of the skin called xerosis. When this abnormal keratinization affects the weight-bearing and high-friction areas of the palms and soles, it results in acquired palmoplantar keratoderma. In documented case studies, patients with severe vitamin A deficiency, often accompanied by other nutrient shortfalls, experienced resolution of their keratoderma after appropriate supplementation.

The Role of Zinc Deficiency

Zinc is another vital micronutrient involved in skin health, wound healing, and immune function. Severe zinc deficiency can lead to a condition known as acrodermatitis enteropathica, which features a distinctive eczematous rash that often affects the periorificial (around the mouth and nose) and acral (hands and feet) areas. This rash can mimic or be associated with palmoplantar keratoderma. Similar to vitamin A, the dermatological symptoms of zinc deficiency can resolve dramatically with supplementation. A case report in the medical literature detailed a young boy whose hard, PPK-like plaques and flexion deformities improved significantly with zinc therapy.

General Malnutrition and Other Vitamins

Often, nutritional deficiencies do not occur in isolation. Severe malnutrition can lead to a broad range of vitamin deficiencies, making it difficult to pinpoint a single cause for the resulting skin conditions. Beyond vitamin A and zinc, some reports have associated deficiencies in thiamine (vitamin B1) and other nutrients with acquired palmoplantar keratoderma. This highlights why a comprehensive medical evaluation is necessary for proper diagnosis.

Acquired vs. Hereditary Keratoderma

Not all cases of thickened skin on the palms and soles are caused by a nutritional deficit. Palmoplantar keratoderma is broadly classified into hereditary and acquired forms. Differentiating between them is a key step in diagnosis and treatment.

Characteristics of Keratodermas


Feature	Hereditary Palmoplantar Keratoderma	Acquired Palmoplantar Keratoderma
Cause	Genetic mutation, typically affecting keratin proteins.	Environmental factors, underlying illness, malnutrition, or medication.
Onset	Often begins in infancy or childhood.	Develops later in life, sometimes triggered by a systemic issue.
Treatment	Symptoms are managed but there is no cure for the genetic condition.	May resolve completely or significantly improve once the underlying cause is addressed.
Progression	Can be lifelong, with varying severity.	Varies based on the cause; can progress or regress based on resolution of the trigger.

Recognizing and Diagnosing Deficiency-Related Keratoderma

Recognizing the signs of a nutritional problem is crucial for a correct diagnosis. While symptoms like thickened, scaly skin and fissures on the hands and feet are common to all keratodermas, acquired cases may be accompanied by a broader set of signs related to malnutrition. These can include weight loss, gastrointestinal issues, eye problems, and other mucocutaneous findings. A detailed nutritional history and blood tests to check vitamin and mineral levels are essential.

Practical Management and Treatment Strategies

For acquired keratoderma linked to vitamin deficiencies, a multi-pronged approach is typically recommended. The most important step is to correct the nutritional deficit through dietary changes and targeted supplementation under medical supervision.

Dietary Intervention: Focus on incorporating foods rich in the identified deficient nutrients. For example, increase intake of leafy green vegetables, sweet potatoes, and carrots for Vitamin A, and legumes, nuts, and seeds for zinc.
Nutrient Supplementation: A doctor may prescribe specific vitamin and mineral supplements to rapidly restore healthy levels, especially in cases of severe deficiency.
Topical Symptom Management: Local skin care remains important to manage discomfort and prevent infection. This includes using moisturizing creams (emollients) and peeling creams (keratolytics) containing salicylic acid or urea to soften and reduce the skin's thickness.
Addressing the Underlying Condition: If the deficiency is a result of malabsorption or another systemic disease, treating that primary condition is paramount for long-term resolution.

For many patients, especially those with long-standing issues or severe malnutrition, correcting the deficiency can lead to a dramatic improvement in skin symptoms. A thorough investigation by a healthcare professional is always necessary to ensure an accurate diagnosis and effective treatment plan. For more detailed clinical information on acquired forms, refer to this NIH study on acquired PPK.

Conclusion

While genetic mutations account for many forms of keratoderma, it is clear that nutritional deficiencies can cause or mimic plantar keratoderma. Insufficient levels of Vitamin A and zinc are well-documented culprits, disrupting the normal process of skin keratinization and leading to thickening of the palms and soles. In cases where malnutrition is the root cause, effective treatment focuses on correcting the dietary shortfall through supplementation and diet, alongside topical skin care. A proper medical diagnosis is essential to distinguish between hereditary and acquired types and to identify all contributing factors for the most effective outcome.

Frequently Asked Questions

Yes, a severe deficiency in vitamin A can lead to abnormal keratinization and skin thickening on the palms and soles, a condition known as acquired palmoplantar keratoderma.

Severe zinc deficiency is a known cause of a distinctive rash, acrodermatitis enteropathica, that commonly affects the extremities and can present with symptoms similar to plantar keratoderma.

General malnutrition leads to multiple micronutrient deficiencies, and addressing these is crucial for resolving cases of acquired palmoplantar keratoderma triggered by poor nutrition.

No, many forms of plantar keratoderma are hereditary and caused by genetic mutations, not nutritional issues. Determining the correct underlying cause is essential for effective treatment.

Symptoms often include abnormally thickened, scaling, and sometimes fissured skin on the palms and soles. Other signs of malnutrition might also be present, such as changes to hair, nails, or overall appearance.

Treatment involves correcting the underlying nutritional cause through diet and supplementation. Topical treatments like emollients and keratolytics are also used to manage the skin thickening.

Good sources of Vitamin A include sweet potatoes, carrots, spinach, and beef liver. Zinc-rich foods include legumes, nuts, seeds, whole grains, and red meat.

Some medical reports have associated thiamine (vitamin B1) deficiency with malnutrition-related plantar keratoderma, indicating that multiple deficiencies can contribute.