Mal de Meleda: A Focused Review

Caroline Perez; Amor Khachemoune


Am J Clin Dermatol. 2016;17(1):63-70. 

In This Article


Historically, vitamin A and related molecules have been used in the treatment of hyperkeratosis, with case studies specific to the use of vitamin A in Mal de Meleda dating back to 1950.[72]

Reed et al.[73] discussed effective treatment with oral 13-cis retinoid acid following failed treatment with corticosteroid, lactic acid, retinoid acid, and emollients. More recently, Gruber et al.[32] showed effective treatment with oral acitretin 20 mg/day plus topical antimicrobial and keratolytic therapy. The main adverse effect of oral acitretin therapy noted in this study was skin dryness. As with other systemic retinoids, the drug must be very carefully administered in women of childbearing age due to the known teratogenic effects.

Stina-Schiller et al.[74] note the importance of regular cleansing of the hands and feet, accompanied by mechanical keratolysis (with pumice stone or other abrasive surface). The same study suggests keratolytic therapy with topical urea-based ointments.[74] Given the increased risk of fungal infection in Mal de Meleda, some practitioners recommend prophylactic topical antifungals be used, while others elect to treat systemically as needed. Because Mal de Meleda is so rare, there are no randomized trials or set guidelines for treatment.[45]

Outside of medical management, there are also reports of surgical resolution of hyperkeratosis in Mal de Meleda following excision with subsequent placement of a fullthickness skin graft. Long-term follow-up (4–29 years) of the grafted skin showed no signs of hyperkeratosis.[26,75]