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Exfoliative Keratolysis
I have suffered with Exfoliative Keratolysis on my hands and feet for 27 years now.
In fact it was only by going online recently that I finally learned the exact name of this condition. No doctor I saw ever put a name to it other than "It's some type of dematitis or exzema." As like many others, I went through all the standard treatments including topical steroids. The ONLY times it has completely cleared was when I would get a cortizone injection in my bad shoulder as well as the one time I was put on a Prednisone treatment for an eye infection. That's it. I live with it. But I would like to know if anyone has an idea as to what brings it on in the first place. Why, out of the blue, does it appear? I have no allergies nor exposures past or present to chemicals or the like. Any ideas? Any treatments that work?

Thanks!
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I get this EK nonsense with exposure to salt water. Even minor exposure is enough to set it off. This is a major problem, especially since I started working as a commercial diver (that's when I first became aware of it) These days it keeps me out of the sea, something that really bothers me - I live to be in and around  the ocean, but the reaction is too severe and disruptive to the rest of my dry-land life. Like everyone else here, I've been to a number of dermatologists all of which have charged me hundreds of dollars and provided no answers, just more expensive prescriptions for things that don't work. The only real answer I've found is to avoid the thing that sets it off.
I live in hope that I'll grow out of it one day.
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Hi guys and omg thank you all very much. my father suffers from this and it is driving himi crazy and he cant even do every day things such as eat or drive his van as he cant bend his fingers because the skin is so taught it rips and bleeds causing severe pain. he has been in and out of hospital for months now and it looked like we were getting nowhere but i have found so much information on this page more than i got at the hospital over the past few months just goes to show you dont need a doctorate to find out whats with you. What i found most interesting is the humidity affecting the condition as my father works is extremly hot and humid conditions (well we are british so anything more than 15 degrees is shorts and t-shirt weather haha) but yes his work is very warm and thats why i think his hands are so bad because even tho he is in extreme pain he still finds strenght to work weird i know? he is crazy. The amount of information of this page alone i think will help alot i have a list of creams and ointments and some injections for my dad to test at the hospital now see if we can make it the slightest bit easier for him. So i just want to say thank you everyone and i will keep you updated with how my father gets on.
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Thanks to everyone that has replied. My EK started 10 years ago and like with most of you, the various medical opinions that I have sought from GP's and specialists were inconclusive.

My skin peeling gets worse around change of seasons. I am a recreational fisherman and I find the drying effect of salt water is terrible. As mentioned - working on cars, boats or in the garden makes the skin sensitive and makes the peeling worse.

I find a homeopathic product called Cutis Compositum helps contain my EK. I still have the symptoms but not as bad as when I stop taking it. You can buy this product online.

At least I now know what the problem is now and I will try Urea cream.

Thanks again everyone.
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Hi,I am 23 and about 3 weeks ago I noticed my fingertips were getting harder, I awoke the next morning to find that they and the palms of my hands had started peeling,I have seen several doctors(there is a HUGE wait for a dermatologist in the part of NZ I live in at present) all to no avail-they don't have any idea what it is,I've tried steroid based creams but after a week of use I found the peeling skin on my Knees also! I jumped on the net and came across the dermnet website which helped me to figure out that it's EK I've got but nobody else seems to have had it on their knees.I'm using LOTS of emollient cream and a silicon cream over the top to try and protect it which seems to sort of keep it at bay-well stops it from peeling more but doesn't clear it up at all.I have no idea what I've come into contact with or whats caused it but I'm busily trying to figure out how to get my normal skin back as I'm sure the rest of you are! I'm going to go back to the chemist that sold me the silicon cream on Friday when I get back(I'm away atm)because he has apparently seen it before but didn't know what it was called(I was on my way to the GP when I spoke to him so didn't pay too much attention).I will keep you all updated with what he says because he did seem really switched on and hopefully he can help us. Mark H NZ
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i also have peeling on my knees it started on fingertip spread to palms, knees and feet. Its really annoying my fingernails are also changing colour and seem to be infected im seeing a dermatologist in 2 weeks hopefully he can fix it. ive had it for a yaer and a half just trying to not let it affect me to much its just a really frustrating disorder iv tried numerous creams and iv strangely found that vicks has worked the best for me so far.
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My 4 year old son has sheets of skin that can be peeled off his hands without pain.  The skin underneath is left to look pink.  On his feet, the dry skin looks more scaly, but he can't peel it the way he does his hands.  
Dermatologists, as many of you have mentioned, have been baffled etc.,  I feel the need to be more proactive, because I can't rely on just their expertise anymore.  

Could someone please post more specific symptoms and detailed descriptions of how their Exfoliative Keratolysis looks.  I am trying to find his diagnosis myself at this point.

I would really appreciate the help.
Thanks in advance.
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So I couldn't get hold of the chemist I spoke to that day but I I have however spoken to another chemist who said to try an Australian product called Eulactol. It claims to be nutrition for your skin and after using it for a week I can see why. Almost immediately the peeling started to recede and it is now almost gone(it's no longer on my knees but I am continuing to apply it). I'm not sure if it's going to completely cure the problem or not but my god it makes a difference - my hands look and feel so much better, I'm using the "hand balm for very dry skin" with no urea content, but they do also make a "hand cream for very dry skin" with a 10% urea content which I haven't tried it yet and this stuff seems to be working. If anyone tries this cream make sure that you're not shy with it - especially at night I find that the more I can coat it on the better my hands are. I work with my hands so it's hard not to abuse them during the day so I put as much as I possibly can on afterwards.
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It is incredibly helpful to read about others who are dealing with this frustrating situation.   I have had peeling hands for about 2 years and it all started during a time of stress when my Mom was ill and passed away.  I also developed 2 staph infections in that time period as well so I think it has to all be related and trigged by the two.  Some of the other things I seem to have in common with some of you are ...peeling knees and elbows and yes my nails do seem to grow much faster than before.   I have been to the dermatologist several times and most recent about a year ago, she gave me a variety of ointments to try including cold tar....nothing was significant.   I am considering going back with my self diagnosis of EK to see if she has any new treatments.

I have used a number of over the counter creams to no avail....Eucerin and Aquaphor seem to help the most.   My husband is a chiropractor and religiously pumps me full of fish oil and most recently some new probiotics thinking it could be fungus related...I have only been taking them consistently for a week and will let you know.   I have used Cold Laser Therapy which helps speed cell repair and previously it seemed to help but most recently had little response excelpt to make it peel more.  
Through reading I have picked up two suggestions Eulactol and Argumented Bethamethosone Dipropionate???   anybody having good results with these?  
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My hands have been peeling for a little over 2 years now... mainly on my fingers, sometimes on the palms.  Some doctors have diagnosed it as an infection, some as eczema or a dermatitis, and another recently said it is dyshidrotic eczema.  But the little blisters that form on my hands and eventually peel are not filled with a fluid and my hands have NEVER itched or scabbed over, so I highly doubt it is dyshidrosis.  Sometimes the skin peels where there are no blisters... its just like the skin is dead almost.  So I have recently self-diagnosed myself with EK.  

Things that have given some or very little relief for me are vaseline (acts as a greasy barrier), clobetasol propionate cream, augmentin antibiotic (possibly a secondary infection at the time, as it does not always work), and oral prednisone, which works pretty well, but is a hazard to take frequently.  

This problem occurs mostly during the spring, summer, and fall.  Suprisingly enough, it is better in the summer than in the spring and fall, but conditions still vary from week to week.  I play college basketball at the time, so it can be very difficult for training and practice.  I will follow the post.

I just got done with prednisone, so my hands are pretty clear right now, but I am sure they will act up again sooner or later.  I got some Augmented Betamethasone Diproprionate ointment today, so the next break out I have, I will try it out and post the results.  Two others on this post have claimed that it works extremely well, so hopefully I will be a third.  

Also, I have heard that shampoos, soaps, detergents, and chemicals can be irritants as well.  I plan on trying a natural line of soap and shampoo to see if it will help the conditions any at all.  I have heard good things about Siena Soap. They have 100% natural soaps and etc. that have no added synthetic fragrences, preservatives, or colorants, and all of the ingredients are natural.  If anthying, I think switching over to such prodects would atleast help some, seeing that my conditions worsen after a shower or when my hands are washed.  
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Great to find this site. I've had EK since I was a teenager (now mid-forties). I'm lucky it is mainly my feet (easier to hide). I get occasional small blisters on my hands, but can have one large blister over half the foot. Never any fluid underneath, just powdered skin. I was misdiagnosed for years - doctors sneered at me for not getting rid of athletes foot (I have probably used every tinea product known to science).

Exfoliative Keratolysis is just one name, and doesn't appear in many skin textbooks. One skin specialist told me it was dermatitis - so generic it was not helpful. Exfoliative is a good word, as I can peel off the blisters like an orange.

Digital photography is great - I just take photos along (after I found the Dermnet NZ website to compare it). I don't associate this with stress - I do get unexplained outbreaks, but also after I've been travelling. I don't know if it's temperature changes, humidity, soft or hard water, but you can almost guarantee it will happen a couple of weeks after I get back.  

Related conditions: I have seborrheic dermatitis, and haven't used a regular shampoo in decades. Now I use T/Gel - in rotation. The menthol one is great for itchy scalps, which leads me to problem number 3:

I get unidentified bumps on my skin, particularly on my scalp and neck, which are incredibly itchy. I call this my "heat rash", as it's often associated with a hot day, or when I'm bundled up against the cold, but I can get this any time on my scalp, neck and back. They look like nothing - slightly red and raised, but are so hard to live with. I resort to steroid lotions when I can't stand it any longer (currently Betamethasone valerate).

Other treatments: here are my life-savers. Skin dryness is a real problem. I use lanolin cream on my feet. If I don't use a lanolin lip balm every night and morning my lip splits and bleeds when I smile (or eat frenchbread...).

Vegetable-based soaps with natural scents (lemon, coconut, rose). I can't wear make-up or creams, but aloe vera at night helps keep my face smooth.

Oh yes, one last thing, my face is allergic to any sun block (no such thing as hypoallergenic for me). My skin turns to concrete and dies - after a few weeks I can scratch off the whole layer. Hats are essential.

My Dad had Psoriasis, but no other family connection. Would be interested to know if anyone has the same combination of symptoms.  
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AUGMENTED BETAMETHASONE DIPROPRIONATE DOES IN FACT WORK.  I had another bad breakout with my peeling hands (its summer, so its pretty common) and have been using the ABD ointment for about a week and they are almost completely clear.  The prescribed dosage is use 2x a day for 2 weeks.  I have been using it 2-3 times daily (mostly 3) and have seen steady improvement over the last week.  After the second week of using it, im hoping to be completely clear (im nearly there).  Then it says to take a week off and use it accordingly afterwards.  It really is a miracle cream, as stated before.  I am also not seeing any real skin thinning as most other steroidal creams cause, atleast after the first week.  
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Thanks, Jamfol. I'm making yet another phone call to my son's dermatologist tomorrow to request ABD.

For the past 6 weeks my son has been using clobetasol propionate cream for his yearly spring/summer outbreak of EK. There's even a new foam formulation of clobetasol propionate that's called "Olux E." Neither has worked well. In fact, peeling seems to be worse, although clobetasol propionate does seem to lessen the severity of the the red/cracking skin under the peeled areas, but that's it. It has NOT stopped the peeling.

Will report back. Thanks for your recommendation.
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I would use the ABD for about two weeks, then use an antifungal cream like ketoconozole for a week or so after.  Because steroids weaken the immune system, and I had a little bit of infection after using the ABD, but the anti-fungal cream helped in a couple of days.  Something that also has given the skin on my hands a lot of strength is fish oil capsules.  Ive been taking around 4,000 mg a day for the past week and have noticed the skin on my hands has become more hydrated.  The oil moisturizes from the inside out and the EFA's help with overall skin health.  Good luck to your son, its such a difficult condittion to live with.  
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I called my son's dermatologist to get a prescription for augmented betamethasone deproprionate....which he declined. Evidently ABD is not as strong a cortisteriod as the one that he was already using, clobetasol proprionate (in either the cream form or the foam "Olux E"). Thus, he is already using the strongest topical for EK that is available. There is no reason to switch to ABD...despite your success with it.

I wish I knew more about these formulations....is it possible that there is something about ABD which makes it more effective than CP, despite CP being the "stronger" topical?

Are there others of you out there who have tried both?? with what kind of results?

I am very happy to try jamfol's recommendation about the fish oil tabs....that's easy enough to do, and plenty of benefits whether it helps the EK or not....

I'll report back.

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Let me join the team here ....I visit my dermatologist on Thursday and I am going to request  ABD and see if she will prescribe.   I also have used CP and truly I don't feel it helps any more than just using Eucerin for keeping my hands lubricated.   Hopefully she will allow me to try and I will let you know the results.  I am curious too that maybe there is something different in ABD that is NOT in other creams and especially CP.   I can vouch for the fish oil....it does benefit in so many ways it is certainly worth adding to your supplement list.  
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Hello my 15 month old son has this I think we go to the dermotologist tomorrow so hopefully we will have some answers.  He was admitted to the hospital over the weekend for what they thought was a toxic staph infection it wasnt.  The palms of his hands an soles of his feet just started to peel.  Thick large pieces im no sure if this is what it is but ive printed all the info to take with me to the doc.  The poor kid it doesnt hurt him at all, he just hates to have it touched cause he is ticklish and with that top layer gone he is soooo much more sensitve.  Ive got some pics on my profile if anyone wants to take a look and see if it resembles theirs I would really appriciate it and any advice for him.  I dont think the gloves would work after all he is 15 months and i cant even get him to leave his clothes on all the time.  Thanks in advance and thank you for all the great information.  All the doctors at the childrens hospital were dumbfounded THANK YOU!!!!!!!
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I FINALLY have been officially diagnosed with EK by my private dermatologist (at a cost of £150 I shoul add!).

It's such a relief just to have an actual diagnosis. He confirmed that there is no wonder-pill / cream, but that we should just try some things to see what might work. I've got another steroid to try as well as some tape impregnated with steroids to put onto the deep cracks overnight.

If this is not sucessful then we're going to try light treatment (UVA) - I'll let you know how it all pans out.
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I've done it. I've succesfully treated my Keratolysis.
The illness is genetic, and will always be part of my life, but it turns out that it was triggered by food intolerance issues.

Since I've been diagnosed with intolerance towards malt, apple, pork, onion, etc., I've change my diet, and my hands have healed to almost completely normal.

Get an ALCAT test done, and chances are, your immune system calms down, and your keratolysis does as well
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TO H_LENZ: Where can you get this ALCAT test done?

TO ALL:  I recently posted on the Augmented Betamethasone Ointment... It helped clear up my hands 60-70% over a 2 wk period, but the condition only came back within a week of stopping use.  I went to my derm last week and he gave me something called Epiceram.  It just came out this year and is  generally new method of treatment, so I dont think it is that popular yet.  The creator of the formula did a study on eczema patients skin and found that the ceramide levels (a natural lipid that acts as a moisturizor in our skin) are significantly lower than that of a normal skin cell.  Epiceram is a lipid based cream that mostly contains ceramide combined with fat and cholesterol.  Unlike most lotions, it enhances our bodies natural moisture function rather than adding moisture through chemically derived lotions.  In a clinical study, Epiceram was found to be as effective as a mid-strength steroid when compared to reducing inflammation and stimulating healing.  The great part about it though is that it can be used longterm and does not thin out the skin as does steroid creams.  So I would think it would be pretty effective in actually preventing breakouts if used daily.  If you are interested, just google "Epiceram" and read up on it.  
I had another breakout and went to my Derm and he gave me this stuff and it has cleared up my hands just as well as the ABD did, but the good thing is that i dont have to discontinue its use.  I have only used it for a week and my hands are cleared up 60%.  I will post back if they clear up completely and how the longterm effects play out...
I also posted on the fish oil... I started hhaving bad chest pain after taking them, so I had to discontinue use...  
Like I said, the ABD did work for me but I broke out again within a week after stopping its use.  Im hoping that Epiceram will keep them calmed down because it can be used long-term.  
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I had posted several months ago, thinking that my son's condition could possibly be EK.  None of the dermatologists had answers, and numerous ointments were tried, without having the skin look normal.

More recently, the past about 2 months, his dermatologist finally diagnosed him with pityriasis rubras pilaris.  I actually took it upon myself to urge her to email the photos of his hands/feet (and even face which began peeling at the end of May), to all the pediatric dermatologists in the Nation.  Finally his condition was diagnosed.  It is extremely rare, and as you can read in the post from several months ago, many of his symptoms are similar to those of you who think you have EK.  The ointment that I am finally pleased with, because it has stopped the peeling, and returned his skin to normal color and texture (his hands are soft and so are his toes!) is Protopic .1%.  

I hope that this will help those of you who are looking for solutions.  Though you may not have Pityriasis Rubra Pilaris as he apparently does, the ointment may enable your skin to go back to normal too.  Best of luck.
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