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What Is Keratolysis Exfoliativa?

By Rebecca Mecomber
Updated Mar 03, 2024
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Keratolysis exfoliativa is a harmless but bothersome skin condition in which the thin epidermis of the skin flakes, blisters and peels off. Known by other names, such as Lamellar dyshidrosis, recurrent focal palmar peeling and recurrent palmar peeling, keratolysis exfoliativa afflicts the palms of the hands and tender soles of the feet. Dry skin flakes blister and slough off, leaving behind tender red spots. The skin disorder is akin to the more serious Acrokeratoelastoidosis of Costa, in which hardened raised bumps, or papules, form. Causes of this condition are relatively unknown, and therefore treatment depends on the severity and discomfort of the patient's condition.

While extremely annoying and perhaps embarrassing, keratolysis exfoliativa symptoms rarely progress beyond the discomfiting skin blistering and peeling. It almost always affects the palms of the hands and occasionally on the soles of the feet. Small blisters appear and crack or burst open on the surface of the skin. The torn skin peels off. The condition is not painful, but the unsightly tender red patches left behind by exfoliating skin make the patient more susceptible to extremely dry, cracking skin.

The causes for the condition are not known and might afflict anyone. Some medical professionals believe genetics might play a part in a certain patient developing the condition; other causes might be excessive sweating, exposure to detergents, solvents or salt water. Skin irritants may exacerbate keratolysis exfoliativa in sensitive patients. Some studies show that it precedes a more severe skin disorder, called pompholyx, a type of eczema accompanied by painful redness and itching. A severe but very rare form of skin peeling, called "keratolysis exfoliativa congenita," is characterized by asymptomatic and continuous peeling from the neck, torso and extremities.

Treatments for keratolysis exfoliativa depend largely on the severity of the discomfort, the spread of the disorder, and if the condition is accompanied by complications such as itching, papules, extreme tenderness and skin cracking, which can lead to infection. Most cases resolve on their own without treatment. Medical professionals suggest keeping the skin clean to prevent soreness or infection. Emollient hand creams containing urea, silicone or lactic acid provide some relief and help defend the skin from bacterial infections.

Keratolysis exfoliativa is a harmless but unsightly skin condition. Due to similar symptoms of other diseases, it is sometimes confused with other skin disorders, such as psoriasis, eczema, tinea and skin burns. This condition presents no pain, itching, papules or lesions and is limited solely to the skin on the hands and feet. Skin lesions or patches that develop raised itchy bumps should always be checked by a physician.

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Discussion Comments

By anon965907 — On Aug 15, 2014

I started with this on my lips so yes, it does appear there. My right thumb is cracked and sore at times. My dermatologist suggested Aquaphor but it does not do much. I use a prescription on my lips but still have flaking and bits that I keep biting off. Boo. I live in Florida so the sun may have some effect though I only walk the dog outside mostly. Just wanted to see what others were going through. My nails are a mess!

By stoneMason — On Aug 23, 2013

Is it possible for this condition to affect the lips?

I have excessively flaky lips and I'm sure that the problem isn't just dryness.

By turquoise — On Aug 22, 2013

@ddljohn-- I have peeling palms too. I'm not doing too much for treatment at this point. I'm looking for a natural cure.

I used a corticosteroid cream for a while but it seemed to make it worse and it's not good to use steroid creams for a long time.

Does yours get worse during summer? My symptoms worsen during hot climate. My doctor thinks that there is a connection between sweating and keratolysis exfoliative. She told me to keep my hands clean and dry.

By ddljohn — On Aug 22, 2013

I thought I had a simple type of dermatitis when the skin on my palms started to flake and peel. I suspected that it was an allergic reaction to the hand soap I was using. I changed my hand soap but instead of getting better, the flakes got worse and turned into blisters.

My dermatologist recognized it right away and said that it's keratolysis exfoliative. Right now I'm using an anti-inflammatory topical cream. It seems to be helping.

Does anyone else here have this condition? What are you doing for treatment?

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