Exfoliative Keratolysis: Management and Symptom Relief

Exfoliative keratolysis (EK) (keratolysis exfoliativa, dyshidrosis lamellosa sicca) is a benign, recurrent peeling of palms/soles (and fingertips). Etiology unknown; associated with sweating, atopy, irritants.

Clinical

Superficial, air-filled blisters → collapse → circular, tender, peeling patches. No inflammation (vs. dyshidrotic eczema). Seasonal (spring/summer).

Management (No Cure, Symptom Control)

• Emollients: Frequent thick creams (urea 10–20%, ceramides, petrolatum) — barrier repair.
• Avoid irritants: Harsh soaps, solvents, detergents; wear cotton gloves under rubber gloves.
• Topical steroids: Low-potency (hydrocortisone) if inflammation; not primary.
• Keratolytics: Salicylic acid 2–6% or urea — cautious, can irritate.
• Phototherapy (PUVA/NB-UVB): For refractory cases.
• Systemic retinoids (acitretin): Severe, extensive cases; teratogenic.

Reassure: benign, self-limited flares. Dermatology referral if atypical or unresponsive.