Peeling sheets of skin on hands and feet

[dippin]

I have been taking my 4 year old son to see dermatologists for over a year now.  His hands and feet have continued to peel ever since he turned 3.  He can peel whole sheets off and tell me it's painless.  The dermatologists that he has seen say they've never seen anything like it.  Today, however, his dermatologist gave a probable cause:  pityriasis rubra pilaris.  However I've looked it up, and though his skin is a bit pinkish-red (where the skin has come off), he's never complained of itching or pain.  In addition, other than the hands and feet, all the other symptoms are nonexistent.  I questioned whether it was Exfoliative Keratolysis, since the "air bubbles" that people speak of look more similar to what is on his hands, however it was dismissed without explanation.  I am at a loss.  Please help.  

[jagesh50]

Localized peeling skin syndrome has been reported,but extremely rare.Acral peeling skin syndromes have a genetic basis.Though not serious,no solution either.VitA,zinc should help.

[Bhupinder Kaur, MD]

Hello,
Various possibilities for peeling hands and feet are trauma and allergic or irritant contact dermatitis like washing dishes without wearing gloves,contact with harsh detergents,soaps and lotions that contain perfume can cause hands and fingertips to become irritated and peel.Sometimes cold, dry air can cause  peeling and dermatitis or fungal infections can also cause peeling. In your son’s case I feel that it can be due to eczema or contact dermatitis.

I would suggest a dermatologist’s evaluation to confirm the diagnosis.Till then wash the areas several times with fresh water. Do not use any cosmetic products at the sites.You can apply some calamine lotion at the rash as it will help in soothing the skin. For mild-moderate symptoms a weak steroid may be used (e.g. hydrocortisone as dermacort), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide). Symptoms can be exacerbated by dryness of the skin.So use good quality moisturizers to prevent moisture loss from the skin.

I hope that helps.Take care and pls do keep me posted on how your son is doing or if you have any additional doubts.Kind regards.

[jagesh50]

APSS is extremely rare,but charecterised by peeling of hands and feet.As Kindd as sugessted follow them,and get the child evaluated.This condition is only clinical interest should no way disturb your child.

[dippin]

Thanks for your input.  

I've actually taken my son to at least three dermatologists to be evaluated with quite fruitless results.  He has tried hydrocortisone, urea 20 and 40, triacimilone, etc., without much improvement.  He was prescribed Dovenex, which according to the doctor is really for psoriasis patients.  It has shown the biggest improvement so far of all the ointments that he has been given.  Though the thickening of his skin seems to have dissipated on his hands, they still continue to peel in thinner layers and only on a the edges of where the old skin and new skin meet.  His feet are still rough and hard in some spots.

I've wondered whether it could be an irritant causing such a reaction, but I can't think of what it could be since he has had it day in day out for over a year.  I mean, we've changed soaps etc., laundry detergents...

I hate to be skeptical, and I want to trust the dermatologist's expertise, however I think I just feel like I need more information.  How does a dermatologist determine whether what he has is something like Exfoliative Keratolysis vs. pityriasis rubra pilaris(which is what his dermatologist believes it is)?

Thanks again.  
I appreciate any feedback from anyone.

[katwoman1977]

Have you looked up pictures online of exfoliative keratolysis or pityriasis rubra pilaris at all? I was diagnosed with exfoliative keratolysis (aka peeling skin syndrome) about 2 months ago. As soon as I got home, I typed in "pictures of exfoliative keratolysis" in my search engine online, and sure enough the pictures that came up looked like my hands and feet. It is very rare, that may be why your dermatologist dismissed it. From the research I have read online, they say that in many cases, both parents of the person that has it are closely related. I also looked up pictures of the pityriasis rubra pilaris and they look nothing like what you have described. You said he could peel the skin off in sheets; in the pictures of pityriasis rubra pilaris it looks like the skin is flaking off. I am in no way a skin expert, but if I were you, I would get a second opinion. Before I was diagnosed with keratolysis, I was misdiagnosed with psorisis by a different dermatologist.