Keratolysis exfoliativa

Keratolysis exfoliativa (also known as"lamellar dyshidrosis", "recurrent focal palmar peeling", "recurrent palmar peeling" ) is a sometimes harmless, sometimes painful skin condition that can affect the focal surface of the fingers and/or the palm or soles of the feet. It is often misdiagnosed as chronic contact dermatitis or psoriasis. It is characterized by dry skin and superficial, air-filled blisters. These blisters can be peeled off very easily and will leave reddish, tender areas. The loss of this corneal layer of the skin, which protects the underlying layers, leaves the skin more vulnerable to dryness and cracking.

Causes
Keratolysis exfoliativa normally appears during warm weather. Due to excessive sweating and friction, in for example athletic shoes, the skin can start to exfoliate. Other factors that can cause exfoliation are detergents and solvents. Another very common cause has been reported from salt water fishermen, who often suffer from these symptoms. It is not sure whether it is from the salt water or whether it is from some bacteria from fish.

Treatment
Normally, exfoliation is restricted to a particular area and normal skin will replace the exfoliated parts, so no treatment is needed. Since keratolysis exfoliativa is caused by friction, detergents, and solvents, these factors should be avoided. Creams, especially those with silicone and lactic acid are also helpful. In severe cases, photochemotherapy is an option.

Prognosis
In most cases exfoliation resolves spontaneously and no lasting damage is seen. However, some patients experience cracking and even bleeding in extreme cases.