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Exfoliative keratolysis
Exfoliative keratolysis is a common skin condition in which there is focal peeling of the palms and less often the soles. It is also known as ‘keratolysis exfoliativa’, and ‘focal palmar peeling’.
Clinical features
Exfoliative keratolysis is more common during the summer months, and most often affects young adults.
The first sign is one or more superficial air-filled blisters on the fingers or palms. The blisters burst to leave expanding collarettes of scale and circular or oval, tender, peeled areas. These peeled areas lack a normal barrier function and may become red, dry and cracked. However, they are not generally itchy.
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The symptoms are aggravated by exposure to irritants including water, soap, detergents and solvents. Eventually normal skin forms, but frequently exfoliative keratolysis recurs within a few weeks.
Sometimes on the ends of the fingers the split in the skin is deeper, in which case the skin feels hard and numb and takes longer to peel off.
Exfoliative keratolysis may precede pompholyx, an itchy form of eczema in which there are small fluid-filled blisters.
It can be confused with psoriasis, in which there are scaly patches or with tinea, but scrapings for fungal culture are negative.
Treatment
Exfoliative keratolysis does not improve with topical steroids, unlike hand dermatitis.
The following may be helpful:
- Protection from irritants
- Emollient hand creams especially those containing urea, lactic acid, or silicone
- Photochemotherapy.