Exfoliative keratolysis

Specialty: Skin.

• dry dehidrosis
• desquamative keratolysis of palms and soles
• dry lamellar dyshidrosis

Why it occurs

• Recurrent and benign desquamative dermatosis of unknown or idiopathic cause characterized by spontaneous detachment of the stratum corneum on the palms and soles of the feet
• Repetitive and prolonged exposure to industrial solvents, alkaline detergent soaps or hot water
• Microtrauma and constant physical friction in the hands or feet (common in athletes or manual workers)
• Sudden seasonal temperature changes (especially at the beginning of spring or summer in warm climates)
• Local peripheral vasomotor lability that produces imperceptible asymptomatic sweating.

Initial workup

Eminently clinical diagnosis based on the visualization of empty vesicles that rupture quickly, leaving collars of asymptomatic circular or lamellar desquamation without an erythematous inflammatory base. Direct examination with KOH to absolutely rule out tinea manuum (ringworm of the hands) or acute dehidrotic eczema.

Standard management

• The use of powerful topical corticosteroids is not required, since there is no significant primary inflammatory component. Hand creams enriched with 10% urea or 12% ammonium lactate — mild moisturizing and keratolytic agents that accelerate the removal of dead scales and soften the skin barrier
• Silicone or dimethicone-based barrier creams — applied before activities that involve contact with water or mechanical friction to protect the epidermis
• Baths or mild astringent compresses if there is a sensation of temporary itching
• Use of protective cotton gloves.