Keratolysis exfoliativa, also known as dyshidrosis lamellosa sicca, is a common chronic inflammatory disorder characterized by asymptomatic symmetrical peeling of palms and soles. ICD-10 - L26
This condition is seen in children and adolescents, less commonly in adults. The cause is unknown. Keratolysis exfoliativa is more common during the summer months and is often associated with sweating of the palms and soles. Some patients experience recurrent episodes of the condition, while others may have a single episode.
The idea that keratolysis exfoliativa is an abortive form of dyshidrotic eczema has been rejected based on histological research.The first symptom is the formation of one or more superficial, air-filled blisters on the skin of the palms and/or soles and/or fingers. In some cases, the condition may begin with localized skin peeling without blistering.
Blisters rupture, leaving wide, reticulated, round, or oval areas of peeling. These areas continue to peel and spread outward, forming large round patches that resemble lace. These areas of peeling skin do not function properly as a barrier and become red, dry, and cracked.
The central area of these patches becomes hyperemic and in some cases painful. However, these areas are usually not itchy. The symptoms worsen with exposure to contact irritants such as water, soap, detergents, and solvents.
Peeling borders of the patches may merge and cover the entire surface of palms or soles, but the dorsal surfaces are not affected.
Eruptions are always symmetrical. Sometimes deep skin fissures may form on the fingertips, making the skin stiff and numb and requiring more time for complete healing. The condition usually resolves within 1-3 weeks, but may recur.- Acral peeling skin syndrome
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