Last reviewed by Editorial Team on August 13th, 2018.
What is Exfoliative Keratolysis?
Exfoliative keratolysis is a common skin condition characterized by recurrent focal palmar peeling that often affects the palms of the hands, the focal surface of the fingers and the soles of the feet.
Exfoliative keratolysis is also known by other names such as keratolysis exfoliativa, recurrent palmar peeling and lamellar dyshidrosis. This form of skin condition is seen with the development of air filled blisters and skin flakes that will later sloughed off leaving the skin extremely dry and itchy. It may sometimes occur at the tip of the finger where the crack may be deeper, resulting to numb sensation and making the finger feel hard.
Exfoliative keratolysis is sometimes mistaken for psoriasis as both have presenting skin patches. The difference however is that, exfoliative keratolysis is limited only to the palms of the hands and soles of the feet. Exfoliative keratolysis is distinct with its blisters that are rather air-filled unlike others which are fluid-filled. It is also usually not itchy unlike the other skin conditions with similar appearance to exfoliative keratolysis.
The skin plays a vital role in protecting the body and the internal organs from any form of infection and other harmful effect of the outside environment. It is also a waterproof barrier and also keeps the fluid in the body. The epidermis or the top layer of the skin is what is involved in exfoliative keratolysis. The epidermis functions as a barrier of the body against harmful pathogens and direct exposure of the body to the ultraviolet rays of the sun which is potentially harmful. An outbreak in the epidermis can give access to microbial pathogens and other harmful elements into the body, posing a threat to the overall health of an individual.
Exfoliative keratolysis is prevalent in children and young adults. It is generally benign and painless skin condition, although it is recurrent and made worse by constant exposure to detergents and soaps. The incidence is also common during the hot summer months and especially common among individuals with sweaty hands. Exfoliative keratolysis resolves spontaneously without lifelong damages. Extreme cases of exfoliative keratolysis however, may cause bleeding aside from cracking of the skin.
Exfoliative Keratolysis Symptoms
Exfoliative keratolysis initially develops with minor air-filled blisters. The blisters will eventually peel off in a circular pattern later exposing a new skin which may be tender.
The symptoms of exfoliative keratolysis are more commonly seen at the tip of the fingers and the palmar surface of the hands. The palmar surface of the hands is initially observed with the growth of blisters that are filled with air rather than fluid as what other common skin conditions have. The blisters will subsequently peel off or split forming skin tags. The formation of numerous skin tags is what makes the hand looks like it is peeling off. The fingers and the fingertips are often seen with skin peeling which are often left with harder skin due to the constant peeling while it takes longer time before it resolves. As the blisters split and new skins are revealed, normal skin will gradually develop. Exfoliative keratolysis however, will recur after several weeks after it has returned to normal skin.
The blisters in the hand right after it burst will leave scales that will make the affected hand crack and reddish in appearance. The scales left on the hand are described as roundish and tender due to the peeling skin. Itchiness however, is not common in the affected area that has burst blisters.
Blisters forming and splitting at the base of the finger often has a deeper crack which will later make the skin feel harder and numb. Exfoliative keratolysis at the base of the finger often takes a longer time to heal or may be difficult to heal due to the constant peeling of the skin.
The incidence of exfoliative keratolysis is generally harmless and painless except that it can affect the cosmetic aspect. The constant peeling of the skin on the palmar surface of the hand is naturally unappealing and can therefore cause embarrassment on the part of the patient.
There is no exact cause of exfoliative keratolysis identified. The disease generally involves the outer layer of the skin or known as the epidermis. This epidermis is composed of multiple layers made of keratin. Keratin is a protein essential for the strength and flexibility of the skin, thus keeping its function as a water barrier. The breakdown in keratin causes the skin to lose its strength and flexibility and impairing its function as a water barrier. The lost of strength of the skin causes it to exfoliate. The cause of continuous shedding of the skin in exfoliative keratolysis on the other hand remains unidentified.
Several factors are being considered to the onset of exfoliative keratolysis. A genetic factor is considered to predispose an individual from developing the disease. Allergy is also another factor believed to contribute to the onset of exfoliative keratolysis.
Exfoliative keratolysis is common during the hot summer months where excessive sweating is common. The constant and excessive sweating of the hands is considered to stimulate the breakdown in keratin thus, the constant exfoliation or peeling of the skin.
The use of soap, detergents and other solvents are being considered to trigger the exfoliation of the skin. Stress is also another factor considered to trigger the onset of exfoliative keratolysis or believed to aggravate the incidence more.
Exposure to saltwater is being considered to cause exfoliative keratolysis. This is based on reports of prevalence among fishermen, although there is no clear implication of saltwater to the incidence while bacteria from the fish caught by the fishermen are also being considered.
Exfoliative keratolysis is a mild and benign skin condition that often resolves spontaneously without lifelong damages. The disease is limited only to the hands or feet and exfoliation is usually replaced with new and normal skin that treatment is not necessary.
The best method of treatment is to prevent exfoliative keratolysis from occurring by avoiding contact with irritants such as soaps, detergents and solvents. Extra care is also necessary, especially during the season where the breakout is common. It is also recommended to keep the hands clean to prevent infection from setting in via the cracks the resulted.
Relief from dryness and other symptoms of exfoliative can be achieved through application of emollients containing urea and lactic acid and are also beneficial in keeping the skin away from infections.