What are the other Names for this Condition? (Also known as/Synonyms)

• Dyshidrosis Lamellosa Sicca
• Exfoliative Keratolysis
• Recurrent Focal Palmar Peeling

What is Keratolysis Exfoliativa? (Definition/Background Information)

• Keratolysis Exfoliativa is a fairly common skin condition that is characterized by localized peeling (exfoliation) of the outer layers of skin of the palms and soles. It is also known as Focal Palmar Peeling and is typically observed in young adults
• The cause of the condition is generally unknown, but it may be aggravated by contact with irritants, such as chemicals and solvents, and is more common in summers. In many cases, Keratolysis Exfoliativa may not require any treatment; the condition is also known to spontaneously resolve in a majority of individuals

Who gets Keratolysis Exfoliativa? (Age and Sex Distribution)

• Keratolysis Exfoliativa are generally observed in young adults.
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Keratolysis Exfoliativa? (Predisposing Factors)

The risk factors for Keratolysis Exfoliativa include:

• A positive family history of the condition is observed sometimes
• Keratolysis Exfoliativa is more common during the warm summers. Around half of the individuals present the condition in summer months
• Individuals with sweaty palms have a higher risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Keratolysis Exfoliativa? (Etiology)

The cause of development of Keratolysis Exfoliativa is currently unknown. Presently, it is not known to occur from genetic factors, even though a family history is occasionally noted.

The following factors may have a role to play in its formation and/or exacerbation:

• Excessive sweating
• Warm weather
• Friction
• Use of harsh chemicals
• Exposure to saltwater (especially seawater)

What are the Signs and Symptoms of Keratolysis Exfoliativa?

The signs and symptoms of Keratolysis Exfoliativa may include:

• Air-filled blister formation on the finger or palm of the hand. The soles of the feet may also be affected
• These break (exfoliate) to leave behind raw red and tender skin beneath
• The lesions are mostly circular/oval in shape with a rim of peeling edges (termed collarettes of scale)
• The tender red skin may turn dry, crack, and even rarely bleed, following which normal skin appearance is noted
• Ends of digits may become hard and numb with thickened skin, which may take time to peel
• These may peel in several layers
• There may be pain and discomfort depending on the severity, but Itchiness is not observed

Recurrence of the localized condition is observed within a few weeks.

How is Keratolysis Exfoliativa Diagnosed?

A diagnosis of Keratolysis Exfoliativa may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation; a visual examination of the palms may help the healthcare provider diagnose the condition
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin patch tests may be performed
• Skin biopsy, if necessary: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms such as:

• Circumscribed palmar hypokeratosis (CPH)
• Contact dermatitis
• Hand dermatitis
• Keratolytic winter erythema
• Localized epidermolysis bullosa simplex
• Palmoplantar keratoderma (PPK)
• Palmoplantar psoriasis
• Pompholyx
• Tinea manuum (fungal infection of the hand)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Keratolysis Exfoliativa?

The possible complications due to Keratolysis Exfoliativa include:

• Emotional stress due to cosmetic issues
• Frequent recurrences
• Interference with daily activities
• Treatment resistance

How is Keratolysis Exfoliativa Treated?

Mild and localized cases of Keratolysis Exfoliativa may not require any medical intervention since the exfoliated areas are generally replaced by normal skin. In others, the following treatment measures may be considered:

• Avoiding known irritants, chemicals, and friction, where possible
• Application of topical agents such as lactic acid or silicone cream. Topical steroids are not known to be helpful
• Oral retinoids
• Phototherapy may be considered for severe cases

Regular follow up visits with the healthcare provider is important and recommended.

How can Keratolysis Exfoliativa be Prevented?

It may not be possible to prevent Keratolysis Exfoliativa in many cases. In some cases, the following steps may be considered:

• Avoid using soaps, detergents, and harsh chemicals
• If seawater aggravates the condition, then minimizing or avoiding exposure to the same
• Where possible, avoid activities that cause friction in the affected palms or soles
• Try to use suitable gloves to protect the hands, where necessary

What is the Prognosis of Keratolysis Exfoliativa? (Outcomes/Resolutions)

• The prognosis of Keratolysis Exfoliativa is generally good as a majority of the cases are self-limited and a spontaneous resolution is noted
• In some individuals, the condition may be severe with frequent recurrences being noted

Additional and Relevant Useful Information for Keratolysis Exfoliativa:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/