Skin Thickening: Why Skin Becomes Thick, Hard or Leathery

Types of skin thickening

Common causes

Calluses and corns

Repeated friction or pressure makes the outer skin layer thicken in self-defense. Calluses form on hands from tools, sports and musical instruments, and on the soles from walking and shoes. Corns are smaller, deeper and often painful, usually on or between toes. See calluses and corns.

Lichenification and lichen simplex chronicus

Repeated rubbing or scratching thickens the skin into leathery plaques with exaggerated skin lines and darker color. It commonly develops on the neck, ankles, wrists, forearms and genital area. It occurs on top of eczema (especially atopic dermatitis) or as lichen simplex chronicus, where an itch-scratch cycle sustains itself.

Scars and keloids

Healing wounds form firm scar tissue. Keloids grow beyond the original wound, often on the earlobes, chest, shoulders and jaw, and are more common in people with darker skin.

Body-wide causes

Scleroderma

Systemic sclerosis is an autoimmune disease in which the body makes too much collagen. Early signs include Raynaud's phenomenon, swollen "puffy" fingers, then tight, shiny skin on the fingers (sclerodactyly) and face, heartburn and difficulty swallowing. It can affect the lungs, heart and kidneys. See scleroderma.

Morphea

Morphea is localized scleroderma that affects only the skin and sometimes underlying tissue. It causes oval patches of firm, waxy skin, often with a lilac edge while active. It does not affect internal organs.

Diabetes

Diabetes can cause thick, waxy skin on the hands with stiff fingers, thickened skin on the upper back (scleredema), and acanthosis nigricans (a sign of insulin resistance).

Thyroid disease

Hypothyroidism makes skin thick, dry and puffy (myxedema). Graves' disease can cause thick plaques on the shins (pretibial myxedema).

Lymphedema and venous disease

Long-standing lymphedema and venous insufficiency cause skin of the legs to thicken, harden and develop a warty or cobblestone texture.

Rare causes

Eosinophilic fasciitis (sudden hardening of the arms and legs, sometimes after strenuous exercise), nephrogenic systemic fibrosis (after gadolinium contrast in severe kidney disease), scleromyxedema, and some medicines.

How the cause is found

A doctor or dermatologist will ask when the thickening started, whether it itches, about friction, rashes, Raynaud's attacks, swallowing problems, breathlessness, diabetes and thyroid history. They examine the skin's texture, color and distribution. Tests may include:

• blood tests: blood sugar, thyroid function, autoimmune antibodies (ANA, anti-Scl-70, anti-centromere)
• skin biopsy
• nailfold capillaroscopy (looking at tiny blood vessels at the nail edge) for scleroderma
• lung function tests and echocardiogram if systemic sclerosis is diagnosed

Treatment

• Calluses and corns: remove the cause (better-fitting shoes, padding, gloves), soak and gently file with a pumice stone, use urea or salicylic acid creams. People with diabetes or poor circulation should see a podiatrist rather than cutting skin themselves.
• Lichenification: break the itch-scratch cycle with strong steroid creams, moisturizers, covering the area at night, and treating the underlying eczema.
• Keloids: steroid injections, silicone sheets, freezing, laser or surgery combined with other treatments.
• Morphea: steroid or calcipotriene creams, phototherapy, or methotrexate for extensive disease.
• Scleroderma: treatment by a rheumatologist for skin, Raynaud's, reflux and organ involvement.
• Diabetes, thyroid disease and lymphedema: treating the underlying condition, compression therapy for lymphedema.

Daily moisturizing with a thick, fragrance-free cream softens most types of thickened skin.

Frequently asked questions

What causes skin to thicken?

Most often, friction or pressure (calluses and corns) or repeated scratching of an itchy area (lichenification). Scars and keloids also thicken skin. Less commonly, scleroderma, morphea, diabetes, thyroid disease and lymphedema cause thickened or hardened skin.

Is thickened skin a sign of scleroderma?

It can be, but most thick skin is not scleroderma. Scleroderma usually begins with Raynaud's attacks and swollen fingers, then tight, shiny skin on the fingers and face. If you notice these signs, see a doctor for blood tests.

Why is the skin on my hands getting thick?

Common reasons are calluses from work or exercise, hand eczema with scratching, and frequent washing. Thick, tight skin with stiff fingers can occur with diabetes or scleroderma, especially if fingers change color in the cold.

How do you treat thick, leathery skin from scratching?

Stop scratching by controlling the itch with strong steroid creams prescribed by a doctor, thick moisturizers, cool compresses, and covering the area at night. Treating the underlying eczema helps. The skin usually softens over weeks once scratching stops.

Can thickened skin go back to normal?

Often, yes. Calluses and lichenified skin return to normal once friction or scratching stops. Morphea patches often soften over several years. Scars and some scleroderma changes may be permanent, though treatment can improve them.