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.
Causes
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.
Cure
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.
Home Remedies
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.
Exfoliative Keratolysis – Pictures
I have suffered from this for 40 years, with occurances every six to eight weeks, lasting for a couple weeks before normal skin returns. I never have had cracking skin or open sores, just molting. I charactorized the molts as a minor molt, medium molt, major molt or mega molt, depending on quickly full hand peeling occurred and how intense it was. I knew when a molt was coming because I could feel a burning sensation and redness between my my fingers. Mind you, 40 years, every six weeks. I tried every OTC cream and moisturizer which might mask the symtems but would not heal them. I tried $60 tubes of prescribed ointments containing urea and other ingredients. No luck. I’m in sales, shaking hands all day every day. Not fun trying to hide this.
So last October, due to typical dry air here in the north, I had common dry cracking skin at the end of my thumb, unrelated to the keryotosis. Wood working is a hobby and wood really sucks the moisture out of your hands. So I put common Vasaline Peteoleun Jelly, or cheap dollar store equivalents, on my thumbs to keep them moist. In the morning and at bedtime or whenever I remebered to do so. Then, I discovered Vasiline was not a bad general moisturizer. So I rubbed it in to my hands along with my thumbs. It wasn’t any greasier, really much less so than Aveno or whatever other moisturizer I used. So I began using it three or four times a day. That was in October. I haven’t had a molt yet and it’s early April. Six months. Nothing! I’m amazed, flabbergasted, WTF. I’ve been dealing with this for 40 years and Vasiline cures it? The girl friends I lost in my 20’s cuz they thought I!was a freak. If I knew then what I know now…..
Try it. Godspeed.
Yeah..its really not fun hiding this….though not serious health wise it kinda takes its toll on your self esteem a lil bit
Please help me. I have had this for 22years and the skin not only peels off, it cracks, bleeds and looks like 3rd degree burns. The pain is intolerable just like a burn. My hands swell and throb and I cannot even turn the handle of a doorknob when it is at its worst.
My hands sound like yours. It’s so painful even water burns my hands. I’ve been to allergist & dermatologist. They prescribed steroid ointments and it still won’t go away. I just got another referral today after shedding tears at my doctors office. Please let me know if you have any other thoughts!
I can’t believe what a common thing this is and doctors have no clue how to cure to it. I’ve dealt with this increasingly for 2 years now. Started on one thumb tip, then moved to index finger. Now it is on both hands thumb, index, and middle finger tips only. Also a little peeling on both palms, which isn’t a bother. But when my fingertips are bad they crack and bleed. it is completely dibillitating (sp?) to the point I can’t zip my zipper or button my shirt.
I’ve been to a dermatologist multiple times and he doesn’t really have any information that is helpful at all. Frustrating. I keep hoping it will just go away just like it arrived but not holding my breath. Btw, I am in my late 40’s.
I will try the vasaline creme mentioned above. Am 71 have had this two years, thought it came with age. I am careful with chemicals and soaps. Have it on the palms near the thumb, not fingers. I have tried many lotions, none worked. Also I use natural oils (Argan, shea and mango butters, etc) for moisturing. want to get a tube of V for my purse.
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