OVERVIEW

What is exfoliative keratolysis?

Exfoliative keratolysis is a superficial exfoliative skin condition that occurs in the stratum corneum of the palms and soles. The main symptom is the appearance of white peeling spots in the center of annular erythema, which gradually expand, commonly known as skin peeling.

If the condition is mild, exfoliative keratolysis often resolves on its own. However, if symptoms worsen and significantly affect daily life, prompt medical attention is recommended.

What is the difference between exfoliative keratolysis and dry peeling?

Although both exfoliative keratolysis and dry peeling are skin conditions that involve peeling symptoms, they are two distinct types of skin disorders. The differences lie in their causes and treatment methods.

1. Different causes: Dry peeling is caused by excessive skin dryness due to loss of moisture. Exfoliative keratolysis is triggered by genetic factors or autonomic nervous system dysfunction^[1].
2. Different treatments:
   • Dry peeling can be treated with topical application of 50% sulfur cream. In more severe cases, additional medications such as vitamin B1 or loratadine may be prescribed by a doctor.
   • Mild exfoliative keratolysis requires the use of urea ointment or vitamin E ointment. For severe cases involving finger cracking or pain, oral medications like vitamin A or vitamin E may be necessary under medical supervision.

SYMPTOMS

What are the typical manifestations of exfoliative keratolysis?

The typical manifestations of exfoliative keratolysis are as follows:

1. Epidermal peeling: The main symptom of exfoliative keratolysis is the appearance of pinpoint-sized white spots on the palms or soles, which gradually enlarge, leading to continuous peeling of the epidermis, and eventually, the entire patch of epidermis may detach. The skin beneath the peeled epidermis remains almost entirely normal.
2. Annular erythema: Annular erythema often accompanies the pinpoint-sized white spots.
3. Burning sensation and pain: Due to the thinning of the skin after epidermal peeling, the affected area may experience mild burning sensations, pain, or skin sensitivity.

What complications may arise from exfoliative keratolysis?

Exfoliative keratolysis has no clear complications, but improper management may lead to multiple recurrences within a year.

How do the symptoms of exfoliative keratolysis differ from those of tinea manuum?

The most obvious difference between exfoliative keratolysis and tinea manuum is that exfoliative keratolysis does not cause itching, whereas tinea manuum is accompanied by itching.

Although both exfoliative keratolysis and tinea manuum are skin conditions, their clinical presentations differ. Exfoliative keratolysis often appears symmetrically, with small white spots on the palms and soles in the early stages. As the condition worsens, these spots may rupture, leading to scaling symptoms, and in severe cases, excessive sweating and localized dryness.

The clinical symptoms of tinea manuum include skin lesions, scaling, and other symptoms on the palms or fingers, accompanied by itching that should not be scratched, as it worsens the itchiness. Tinea manuum is caused by fungal infection, typically appearing on one side, is contagious, and can spread to other areas of the skin.

CAUSES

What are the common causes of exfoliative keratolysis?

The exact cause of exfoliative keratolysis is unclear, but it is generally believed to be related to excessive sweating, especially in the hands and feet. Additionally, some individuals with this condition may develop it as a side effect of taking rosiglitazone (an insulin sensitizer).

What diseases are associated with exfoliative keratolysis?

Exfoliative keratolysis is associated with dyshidrosis, sporotrichosis, and hyperhidrosis.

Hyperhidrosis: Hyperhidrosis causes excessive sweating in the hands and feet, leading to dehydrated, overly dry skin. It may also disrupt nerve function, causing sweating disorders, which is a major contributing factor to exfoliative keratolysis.

Exfoliative keratolysis is not only linked to diseases but also related to personal emotions and immune resistance.

Who is prone to exfoliative keratolysis?

People frequently exposed to cleaning products, those with an unbalanced diet, or those in contact with harmful substances are more susceptible to exfoliative keratolysis.

1. Exposure to cleaning products: Cleaning products contain high levels of alkaline substances, which can excessively dry the skin and cause peeling, increasing the likelihood of developing exfoliative keratolysis.
2. Unbalanced diet: Individuals with poor dietary habits, such as picky eating or avoiding fresh fruits and green vegetables, may suffer from vitamin deficiencies, making them more prone to this condition.
3. Contact with harmful substances: Harmful substances contain chemicals and heavy metals, which not only damage the body but also irritate the skin. Prolonged exposure can easily trigger exfoliative keratolysis.

To prevent exfoliative keratolysis, it is important to maintain skin hydration, drink plenty of water, and consume vitamin-rich foods.

DIAGNOSIS

Under what circumstances should medical attention be sought for exfoliative keratolysis?

Medical attention is required for exfoliative keratolysis in cases of recurrent episodes, extensive skin lesions, peeling scales, excessive sweating, or severe symptoms.

1. Recurrent episodes: If exfoliative keratolysis causes severe peeling, occurs frequently within a year, or lasts longer than 2 weeks in a single episode, medical consultation is advised.
2. Extensive skin lesions: If the affected area continues to expand, covering large portions of the palms or soles, or interferes with daily life and work, a visit to the doctor is necessary.
3. Peeling scales and excessive sweating: If peeling scales are accompanied by excessive sweating, prompt medical attention is required to prevent worsening symptoms.
   In summary, early-stage exfoliative keratolysis usually does not require medical intervention. However, if symptoms persist, recur frequently, or are accompanied by severe hyperhidrosis, medical treatment is recommended.

Which department should be consulted for exfoliative keratolysis?

For exfoliative keratolysis, patients should visit the dermatology department.

How is exfoliative keratolysis diagnosed?

In addition to visual examination, doctors primarily use the following methods to diagnose exfoliative keratolysis:

1. Dermatoscopy: This allows direct examination of skin lesions for rapid diagnosis.
2. Fungal testing: Helps rule out fungal infections as the cause of peeling.

Which skin conditions are easily confused with exfoliative keratolysis during diagnosis?

Exfoliative keratolysis is often mistaken for other skin conditions due to similar clinical presentations, including tinea manuum, dyshidrotic eczema, contact dermatitis, and hand-foot eczema^[2].

1. Tinea manuum: More common in summer, it causes blisters or erosions between fingers, often with peeling, itching, and possible fungal infections elsewhere.
2. Dyshidrotic eczema: A type of eczema characterized by small, transparent blisters on palms or fingers, accompanied by itching and later peeling, with a tendency to recur.
3. Contact dermatitis: Typically acute, triggered by exposure to irritants, with localized redness, blisters, erosions, and itching at the contact site.
4. Hand-foot eczema: Presents as blisters on hands or feet (not limited to palms), often with itching, roughness, scaling, oozing, and thickened skin.

TREATMENT

Can exfoliative keratolysis heal on its own?

Exfoliative keratolysis may heal on its own, depending on the severity of the condition, its underlying cause, and the care provided.

1. Severity: Mild cases with minimal symptoms often resolve without treatment in 2–3 weeks. However, if symptoms persist or worsen, medical attention is advised.
2. Care: Proper skin hygiene and moisturization can promote self-healing. Conversely, frequent use of alkaline soaps may aggravate the condition.

How is exfoliative keratolysis treated?

Exfoliative keratolysis often requires no treatment, as it may resolve once scaling subsides. Common medical treatments include:

1. Topical salicylic acid to aid in exfoliation for mild cases.
2. Urotropin for patients with excessive sweating.
3. Low-dose corticosteroids (oral or topical, e.g., triamcinolone acetonide) for severe cases, followed by moisturizers for maintenance.
4. Vitamin A or E supplements under medical supervision.

What is the prognosis for exfoliative keratolysis?

Most cases have a good prognosis. However, persistent symptoms or aggressive peeling may lead to secondary skin damage or infections.

DIET & LIFESTYLE

What should patients with exfoliative keratolysis pay attention to in daily life?

Patients with exfoliative keratolysis should avoid contact with chemicals, protect the affected area, and supplement nutrition for the body.

1. Avoid exposure to irritating chemicals: Some chemicals contain harmful ingredients and heavy metals that can irritate the skin and trigger exfoliative keratolysis, so stay away from such substances.
2. Protect the affected area: Exfoliative keratolysis causes peeling skin, so proper skin care is essential. Avoid forcibly tearing off the skin, as this may lead to infection. Maintain skin cleanliness to prevent bacterial growth.
3. Supplement nutrition for the body: To promote recovery and prevent recurrence, ensure adequate nutrition intake. Consume foods rich in vitamin A, such as pork liver, tomatoes, and carrots.

PREVENTION

How to prevent exfoliative keratolysis?

Exfoliative keratolysis can be prevented through a balanced diet, avoiding harmful substances, and proper skin care.

1. Balanced diet: Maintain a well-balanced diet and consume foods rich in vitamin A, such as chicken liver, pork liver, tomatoes, and oranges.
2. Avoid harmful substances: Harmful substances include lead oxide, polybrominated diphenyl ethers, and cadmium compounds. Prolonged exposure to these substances can harm health and trigger exfoliative keratolysis, so it is best to avoid them.
3. Skin care: To prevent exfoliative keratolysis, proper skin care is essential. Use moisturizing skincare products, maintain skin cleanliness, and apply sunscreen when going outdoors.

By taking preventive measures in daily life, the onset of exfoliative keratolysis can usually be avoided.