Exfoliative Keratolysis

Exfoliative keratolysis is a common skin condition characterized by recurrent focal peeling that often affects the palms of hands, the surface of the fingers, and the soles of the feet. It manifests as air-filled blisters and skin flakes which will later slough off leaving skin dry and itchy. It can occur at the tip of the finger, resulting in a deeper crack which can lead to a numb sensation and make the finger feel hard.

Exfoliative keratolysis is prevalent in children and young adults. It is generally benign and painless though it can be made worse by constant exposure to detergents and soaps. The incidence of this condition is more common during summer months, and especially in individuals who tend to have sweaty hands. It usually resolves spontaneously with no long lasting damage, although extreme cases may result in bleeding as a direct effect of the cracking skin.

The first signs of exfoliative keratolysis are the air-filled blisters which usually appear on the palms and fingertips. These will eventually peel off or split and form skin tags. The peeling skin of the fingers and fingertips can lead to harder skin which can take a longer time before they resolve. As the blisters split, a new skin will be revealed. Though the skin will be tender, it will gradually develop into normal skin. However, the exfoliative keratolysis will recur after several weeks.

Although exfoliative keratolysis is generally harmless and painless, it is unattractive and can cause embarrassment on the part of those affected.

Exfoliative keratolysis involves the outer layer of the skin or the epidermis. The epidermis is composed of multiple layers of keratin, a protein essential to the strength and flexibility of the skin. These characteristics enable the keratin to serve as a water barrier. The breakdown in the keratin causes it to lose its strength, flexibility, and effectiveness as a water barrier which, in turn, causes the skin to exfoliate.  The cause of the breakdown in keratin is unknown although factors such as genetics and allergies are being looked into.

Excessive sweating can stimulate the breakdown in keratin which, in turn, exacerbates the peeling of the skin which is why exfoliative keratolysis is more common in summer months and among those with naturally sweaty hands. Soap and detergents will also trigger the exfoliation of the skin and stress is believed to trigger the incidence of the condition as well as aggravate symptoms.

Exfoliative keratolysis resolves spontaneously without lifelong damage, so treatment is not necessary. To prevent exfoliative keratolysis, it is recommended to avoid contact with irritants like soaps, detergents and solvents which will trigger the exfoliation of the skin. Extra care is also recommended during the seasons when breakouts are more likely to happen. One should also keep hands clean to prevent infection from setting in through the cracks resulting from the condition. Relief from dryness and other symptoms can be achieved through applying emollients containing urea and lactic acid. These are also effective in keep the skin from becoming infected.