Exfoliative keratolysis is a skin condition marked by recurrent peeling of the skin, especially the skin on the palms of the hand and soles of the feet. It affects the uppermost layer of skin, i.e., the epidermis. As the condition is marked by focal peeling of the skin surface on the palms, and sometimes the soles, it is also referred to as ‘focal palmar peeling.’ Other names of the skin disorder are lamellar dyshidrosis, keratolysis exfoliativa, and recurrent palmar peeling.
Exfoliative keratolysis patients may suffer from blisters filled with air and flaky skin, which eventually sloughs off and leaves very itchy and dry skin in its wake. Sometimes, if the finger tips are affected, then the associated cracks may go deeper and resulting in hardening of the skin and numbness. Severe cases may increase the risk to secondary bacterial infections of the skin.
The exact cause of exfoliative keratolysis is not known. However, it may worsen with prolonged exposure to soaps and detergents. The condition is more widespread in summer months; often tends to affects young adults and children; and people with sweaty hands are more vulnerable.
Exfoliative keratolysis may occasionally be thought to be psoriasis as both conditions are affected by skin flaking. However, it is different in the sense that the condition primarily affects the soles and palms. Also, unlike other similar appearing skin disorders, exfoliative keratolysis skin defects are not that itchy.
Usually, it is a harmless and painless condition that usually resolves on its own and does not require any treatment. Bleeding and cracking, if any, may require medical attention.
Exfoliative keratolysis – symptoms
Some of the signs and symptoms are listed below:
- Initially, exfoliative keratolysis occurs as small blisters filled with air, unlike most blisters which are full of fluids. These blisters often affect the hands’ palmar surface.
- The blisters may then peel off in a circular manner, or split or crack to develop into skin tags. Scaling of skin may also occur; it may be reddish, cracked and/or rounded. The development of many skin tags is what gives the peeling appearance to the palms. After the skin layer has peeled, new and often tender skin may be exposed. Such skin will slowly become normal and less tender.
- In addition to the palms of the hands and the tips of the fingers, the soles of the feet may also get affected by exfoliative keratolysis skin problems.
- The fingertips and fingers affected by peeling may suffer from harder skin re-growth, if there is continuous skin peeling. In such cases, the skin may take a long time to revert to normalcy.
- If the base section of the fingers are affected by exfoliative keratolysis blisters, then patients may suffer from deeper cracks in the skin, thereby causing numbing sensations and hardening of the skin. Such cases are marked by constant skin peeling, healing difficulties, and prolonged healing time.
- The areas affected by ruptured blisters are generally not accompanied by itchiness.
- Exfoliative keratolysis tends to recur many weeks after the condition is cured and the skin reverts to normal.
- Even though the skin disorder is painless and harmless, its ugly appearance may result in embarrassment, lowered self-esteem, and even depression.
- Severe skin peeling may leave the area vulnerable to the harmful effects of the UV rays and secondary infections, which may even pose a threat to the general health and well-being of the patient.
Doctors are unaware about the cause of exfoliative keratolysis.
- However, it is known that the skin condition usually affects the epidermis. This top skin layer is made up of many layers of keratin, a protein which plays a vital role in maintaining the flexibility and strength of the skin as well as promoting the skin’s function as a barrier to water.
- Exfoliative keratolysis is marked by breakdown of keratin layers, which subsequently leads to loss of flexibility and strength of the skin and lowers its capacity to resist water, eventually resulting in exfoliation or peeling of the skin.
- The reasons for constant skin peeling associated with exfoliative keratolysis are as yet unknown.
Some of the risk factors which may increase the susceptibility to developing exfoliative keratolysis are listed below:
- The presence of underlying allergic conditions may cause exfoliative keratolysis as a symptom of an allergic reaction.
- A genetic predisposition to the skin disorder, which may trigger exfoliative keratolysis after exposure to certain environmental or other external factors.
- Detergents, soaps, and other solvents are thought to activate skin exfoliation reactions.
- Hot summer months are associated with increased perspiration. Prolonged and continuous sweating can degrade keratin layers and result in skin peeling and exfoliative keratolysis.
- Exfoliative keratolysis is often quite widespread among fishermen. Hence, it is thought that saltwater or the bacteria present in fishes may contribute to kin peeling. However, there is no significant empirical evidence to this effect.
- Stress can either trigger the onset of an episode of exfoliative keratolysis, or worsen a current ongoing case of the skin disorder.
Exfoliative keratolysis is a benign and minor skin condition that generally cures on its own without any medical treatment and without causing any permanent skin damage.
Treatment is usually not necessary as the skin that gets peeled off from the palms and soles is naturally replaced with a new layer of healthy skin. Unlike other skin disorders, topical steroids do not help treat exfoliative keratolysis.
- Emollients with lactic acid, silicone, or urea content are prescribed to alleviate skin dryness and other symptoms of exfoliative keratolysis. They are also helpful in prevention of secondary infections of the affected area.
- Severe cases may require photochemotherapy.
The best treatment option for the skin disorder is prevention.
- Ensure that the hands and feet are kept clean so as to prevent growth of pathogens and infections in the skin cracks.
- Susceptible people need to be more careful during the summer months and take steps to avoid increased sweating.
- Avoid regular or prolonged contact with soaps, detergents, and other allergens and irritants.
A healthy, balanced diet goes a long way in preventing the condition. Consuming almonds, walnuts and cashews definitely help. Also you can keep your hands moisturized by using a good quality hand-wash,applying fresh Aloe vera juice or cream or even soaking your hands in an oatmeal bath.