Exfoliative Keratolysis

What is Exfoliative Keratolysis?

Exfoliative Keratolysis is a skin disorder where the uppermost layer starts peeling. It is also named as “Focal palmer peeling,” “Keratolysis Exfoliativa” and “dyshidrosis lamellose sicca.” There is no proven medication for treating this disorder, but a proper management strategy can provide some relief.

Image Source: www.dermnetnz.org

Exfoliative Keratolysis Causes

It involves peeling of the epidermis having different layers of Keratin. However, it is assumed that for specific reasons corneocytes prematurely separates from each other causing this disease. Normal skin forms with time but it reappears within a few weeks. Specific factors initiate Exfoliative Keratolysis while genetic factors may also be responsible.

  • Summers: Excessive sweating makes the situation worse as it arouses keratin to break down resulting in skin peels.
  • Detergents: Detergents, soap, and other solutions heighten skin exfoliation as it contains chemicals which dry up the skin causing skin cracks.
  • Stress: If the disease is already a problem, stress can heighten it further.
  • Salt Water: Research suggests that salt water exposure, especially among fishers leads to this disorder. However, there is still confusion if the bacteria in the fish or the salt water are responsible.
  • Allergies: Other skin problems can aggravate it due to air pollution, food, and other factors.
  • Dry Skin: Dry skin as a result of medications, weather, and health issues increase the chances.

Exfoliative Keratolysis Symptoms

The symptoms are small circular air-filled blisters on palms or fingers leaving tender, expanding and peeled areas open to different environmental factors. The openness results in making skin drier, cracked, red and tender. However, the patient does not suffer from any itchiness or pain.
In rare cases, the cracks can become more profound, and the skin on the fingertips split making the area numb and resulting in infection and illness. After breaking of the blisters, normal skin forms gradually. But the disorder reoccurs after a few weeks when the surface has returned to its normal stage. It is painless, but the appearance of the peeling skin might lead to depression and embarrassment.

Exfoliative Keratolysis Diagnosis

The patient is usually diagnosed after clinical examination. Symptom history is crucial to focus on the risk factors. After performing a skin test (or patch test) diagnosis is approved.

Exfoliative Keratolysis Differential Diagnosis

Before treating Exfoliative Keratolysis, other skin problems should be ruled out with which it is often confused with. They are:

  • Contact Dermatitis
  • Palmoplantar Psoriasis
  • Eczema
  • Tinea (fungal infection)
  • Localized skin blistering ( Epidermolysis bullosa)
  • Psoriasis
  • Pompholyx (characterized by blisters which are filled with fluid)

Exfoliative Keratolysis Risk factors

These blisters are not painful, but if poked with unclean items or nails, the area can get worse as it increases its chances of infections. The tender skin under the blisters can get harmed by the UV rays before the skin becomes normal. Other risk factors:

  • Allergies can worsen this disease
  • Genetic skin problems
  • Stress
  • Saltwater, Sun, Sun poisoning and bacteria can trigger the consequences

How long Exfoliative Keratolysis takes to heal?

The problem does not have any definite cure which makes it repetitive. However, there are medications that basically soothe the area without addressing the root cause. Once its symptoms are healed, the problem hibernates reappearing after a specific period. It is always ideal to treat these problems as early as possible. Mostly, patients visit a physician when the problem has already worsened making the condition difficult to manage.

Exfoliative Keratolysis Treatment

The ideal treatment is avoiding the risk factors that are its primary causes. Make sure to clean hands to prevent bacteria from spreading and developing as it penetrates inside the open skin and worsesn the situation. Doctors also prescribe applying cortisone creams, topical steroids, emollients with lactic acid, urea and silicone. Possible treatments include:

UV Radiation Treatment

Also known as PUVA (photochemotherapy), the process uses ultraviolet radiation to treat skin problems. It also includes psoralens application, plant element that has trisoralen, methoxsalen and methoxypsoralen. It is applied when the disease becomes severe. However, it also has different side effects like skin cancer, eye damage, itching, and burning.

Lactic Acid

The most common way of treating this problem is the application of lactic acid hand cream containing ingredients like urea and silicone. In the outer epidermis, the natural moisturizing element is Urea which prevents dryness, excessive scales that lead to skin peeling. It also strengthens the skin barrier that prevents the disease from reoccurring.

Exfoliative Keratolysis Home Remedies


Dry skin is both a cause and symptom of Exfoliative Keratolysis. Therefore it is vital to keep the skin moisturized throughout the day. The best natural moisturizer is coconut oil as it has antifungal, antimicrobial and antibacterial properties which speed healing and moisturizes as well as soothes the skin.

Natural Hand Soak

Soaking hands or affected area in oatmeal water for 15 to 20 minutes will improve the symptoms.  Add few drops of essential oils that have anti-inflammatory properties to boost the healing process. Some recommended oils are clove oil, ginger oil, myrrh oil, frankincense oil, and lavender oil.

Plant Based Application

Make homemade cream with Shea butter, raw honey, and coconut oil. Applying aloe vera gel, cucumber juice, pineapple juice and witch hazel can also be beneficial.

Prevention of Exfoliative Keratolysis

Exfoliative Keratolysis is entirely different from other skin diseases in regards to symptoms or treatment, and it does not respond well to anti-inflammatory medications or clinical drugs. With no ideal drug therapy, the best way is to take preventive measures. There are some measures listed below:

Proper Diet

Reduce intake of fried foods, processed foods, high sugar foods, additives from the diet. Increase intake of anti-inflammatory foods rich in fatty acid like wild caught fish, flaxseed oil, and other options having healing properties like probiotic-rich foods, chia seeds, pumpkin seeds and vitamin A rich foods.

Avoid Chemical Products

Avoid harmful bathroom products as they are rich in toxic chemicals. Wear gloves before exposing hand to these solvents.

Maintain hygiene

Maintain proper hygiene, like washing your hands and applying moisturizer twice a day. Frequently trip toenails and fingernails as the accumulation of bacteria inside nails can worsen the situation. Use lotions and creams which contain ingredients like salicylic acid, lactic acid, and urea.


Summer season requires extra attention as the palm tends to sweat. Using oral glycopyrrolate or Drysol reduces heavy sweating.

Exfoliative Keratolysis Pictures

Image Source: www.dermnetnz.org


Image Source: www.dermnetnz.org


  1. https://healthmaza.com/exfoliative-keratolysis/
  2. https://www.dermnetnz.org/topics/exfoliative-keratolysis/
  3. http://straightfromthedoc.com/exfoliative-keratolysis/
  4. https://www.doctorshealthpress.com/skin-care-articles/exfoliative-keratolysis-causes-treatment/

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