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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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Avatar universal
Hi all – I first posted about EK on this forum in 2008 (twice), and again in 2012, and am now posting an update again in 2016.  I am going to have to do 3 posts by the look of it – keep exceeding the limit.

PART 1:

I am now an almost 60 year old male and have had the condition Exfoliative Keratolysis (EK) for over 40 years.  Up until 2010, I was in a regime of ‘damage limitation’ trying to manage the situation, after many many years of Doctors, Dermatologists, Naturopaths, Herbalists and ‘Theorists’.  Some things worked, most things didn’t, some made it worse, some made it better. Then in 2010 I stumbled upon a treatment that worked – which I passed on in 2012. In 2014 I found something that works even in a very hot climate and I am now passing that on for others to look at.

Background (mainly from previous posts):   I believe that the EK condition is related to a ‘fault’ in the epidermis layers of the type of skin that is only on two parts of the body (the palms of hands, and soles of the feet).  After many years of ‘research’ and trial and error (my parents were medical professionals), and also some related personal medical issues, I am convinced that it is related (directly or indirectly) to auto-immune diseases.  In 2012 I was diagniosed with Sjrogens syndrome and I also had one espisode of DVT – there is a link between these internal ‘blood disorders’ and some skin conditions like EK (much research is being done - maybe one day they will cure it).

Many years ago I lived in a warm/temperate climate and it was only after some years that I noticed that the EK got worse when the weather was hot, especially after periods of hand contact activity (eg hammering nails, fixing cars). Actually I noticed how the EK was much better in the 2-3 months of cool weather.  We once went on a 3 week holiday to the snow /skiing – and the EK was better almost immediately and then went away after 1 week – but it came back a few weeks after we returning to the hot weather at home.

I moved (about 20 years ago) from that temperate city to a much cooler mountain city (Australia).  There I would only have bad EK for 4-6 months of the warmer summer, and it would go almost dormant for the 6-9 months of autumn/winter/spring.  It was clearly all dependent on the weather.  In winter the temperature got down close to 0C (32F) each night and usually only got up to +15C (60F).  In summer it was from 15C up to 30C. However, it was a catch 22 situation – I didn’t like the cold much, but loved what it did to the EK.  I believe the cold weather makes the EK go dormant because it helps the normal healing process of the skin. I think that is because of the change in blood/fluid flow caused in the hands and feet in cold weather, and also because less moisture is lost through the skin naturally.  I am aware of people who have moved to much colder climates year round (Canada, London, etc.) and the EK has all but disappeared.  For those going through extreme problems with EK in a hot climate area, I still strongly recommend moving to a colder climate - life is too short.

As many have found out themselves, all the topical steroids/cortisone and injections and all those other remedies (both natural and ‘modern’) that I have tried are not the answer. They only 'repair' the damage and assist damage limitation, but the EK always comes back (sometimes worse).  There are many prescription drugs and natural options/cures available - and I have tried most of them. Going down this path lead to a cycle of repair and damage – and it was always a matter of ‘damage limitation’.  Living in a cold climate was a big help – but unless I was prepared to live in an arctic climate, then it would always come back whenever the weather got warm.  Once I did look into getting an invitation to spend a year on the antarctic research station and see if that would make the EK ‘burn itself out’ – but family and work excluded that option.

Then in 2010 I achieved some success for nearly 2 years in making EK dormant for most of the year and I passed that on in this forum in 2012.  In summary:  In 2010 I had the misfortune of putting a knife through my left hand.  After surgery I had my left hand in a hand/wrist cast for over 3 weeks. After removal of the cast all the skin on my left palm completely peeled off in a couple of days. What happened next was very surprising. Whilst my right hand was already starting to go through the usual summer weather problems with EK, my left hand was completely EK free for quite a while after the skin had peeled off.  Slowly over the next month or so, the left hand slowly caught up with the right, and both hands were again EK prone (but the left one was always a little better).  

This caused me to think about why peeling the skin of the left hand made it so much better.  Then I remembered that many years ago one of the attempted treatment that a Dermatologist had me do for a while, had resulted in the skin on the palms of my hand going yellow and peeling off a lot – and the stuff smelled bad (tar).  This treatment involved soaking my hands in a Pinetarsol solution 4-5 times a day.  At the time I thought this was a disaster and didnt go back to him, because the treatment made going to work and social situations somewhat embassing. But after the knife experience, I started thinking again about removing the ‘bad’ skin and therefore allowing the ‘good’ skin to heal and come through.  So I decided to undertake the same process with Pinetarsol, and this time I committed to keep going with it no matter what (or whatever comments are made by others).  I will tell you young people now, one the best advantages of getting old(er) is that you will start to care less and less about whatever negative things other people may say or think about you.  Keeping going with the pinetarsol treatment was not an easy option for a 30 year old, but as a 50 year old I genuinely didnt care a ‘rats rear’ about what others may think/say.

For the next few weeks I undertook the process and much of the skin on my palms peeled off – after going ‘yellow’ in colour (and my hands smelled).  In the first week it was the same slow and ‘messy’ peeling of the skin as before (20 years previous), but then it was less and less - and more and more ‘healed’ patches were evident.  I kept it going and slowly over another week or so I could see that the skin was definitely getting better, and that there was no more new EK developing. I kept this up for the rest of that summer and it worked.  And once the bad skin was gone, my hands didnt smell as much and they looked normal (not yellow).

Before the next summer (2011-2012) I decided to try it again, so a month beforehand I started soaking my hands in Pinetarsol about 4-5 times a day.  At the end of summer in 2012 my hands had been great – there had been only one bad EK outbreak, and a few small ones here and there.  The bad EK outbreak happened when I went to India for 2 weeks (didn’t take Pinetarsol with me), but after a few weeks back home and the treatment, the hands were OK again. The little outbreaks happened when I was slack in the management routine and the weather was particularly hot for a few days. That was when I posted my ‘treatment’ on this forum (see below). IMO the reason the treatment worked (like the hand in a cast for 3 weeks) was because it completely stripped off all the bad skin.  As you know, EK does not occur ‘evenly’ – some parts of hands are good, others developing, and others bad. The pinetarsol strips all the bad skin off at the same time allowing the good skin to develop – and the good skin last longer and stays good, as long as the bad skin is stripped away (using the pinetarsol).  

(see part 2)
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Avatar universal
PART 2:

This was my management plan that worked in 2012:  Pinetarsol – about 30ml per 2 litres of water – soak hands at 4-5 times a day (sometimes more) for 2 minutes, and occasionally for 5-10 minutes (in front of TV) – always after a shower/bath and after washing hands (not using soap).  Because it is not cheap I used a water container (2 litre) and kept the same solution for a week – remember to wash/rinse hands first before placing in solution.  
I would also still apply a small amount of the Du’it Foot and Heel Balm each night (very greasy) – it has 25% Urea Cream.
And I had a hand cream that I would apply when needed (hands would still dry out) and which would not be greasy on the hands – Vaseline Intensive Care.  
I would also not use soap – only Dove Exfoliating Soap (non-soap) and Dove Shampoo.
Surgical Gloves – Nitrile and Powder Free Examination Gloves. For when appplying any gels/sprays/etc to the body/hair.

Now it is 2016 and things have changed dramatcially – both with the EK and my life.  In late 2012 I met my now wife, a lovely Thai lady and in 2014 I retired and we moved to Thailand. This was an issue for me because of the hot climate, but with my new EK treatment I was confident that I would be OK. The disaster that later arrived was caused by the over-zealous customs nazis who refused to allow me to enter Thailand with the pinetarsol (even with a Docs letter).  A month later my hands were an EK disaster zone – creams etc not enough.  Pinetarsol not sold in Thailand, and nothng in the Chemists would work.  A friend sent some Pinetarsol over a few weeks later (illegal but who cares) and I started the treatment again. But the EK was not responding and although there was a slight improvement, after a month we were looking at other options (including going back to Aust).  

My wife convinced me to try a skin clinic – and after researchiong things I ascertained that Thais are particularly suseptible to skin issues and that young Thai ladies are extremely conscious of their skin. This meant that the ‘skin clinic’ that I had pictured as a single Dermatologist and receptionist, was in fact as big as a Hospital in Australia.  And they had extremely well qualified Thai Dermatoligists who trained in USA and UK.  My research also located the most recommended Thai Dermatologist who spoke English.  So what I did was ‘summarise’ my medical history in writing – all the treatments and all the medications etc, and old the old photos of my hands.  I made and appointment and the Dermatologist read the ‘report’ and looked at the photos and examined my hands, and then said ............... you have Exfoliative Keratolytis (with a Thai accent). I was stunned – this was the first medical professional to ever say those words, but did I really hear them, was I wrong because of the accent. I said ............. “what”.  She replied – ‘you have focal palmer peeling’(in a funny Thai accent).  I was so happy and I took out the printed pages from the NZ website that details EK and showed it to her. She looked at it and said “Yes, that is what you have”.  

After she realised I was well versed in EK, we talked further and she confirmed that there is no cure, but she said she can provide something ‘stronger’ that will make it dormant again. She explained that pinetarsol (or any other similar treatment) will not last long in Thailand – too hot and humid.  She advised she can provide me with something very strong but with side affects - but maybe I could give it a try. I was ready to try anything, and agreed.  She pointed out that it would mean I cannot give blood for 3-4 years (never again at my age), should not drink alcohol, should not go out into direct sunlight, and that I will lose some hair (probably come back if stop) and I might get headaches, nausea and my eyesight maybe affected – and that if I was a female I should not have a baby for many years.  I am now thinking ‘Wow this IS serious’. OK tell me more I said.  

You must have blood tests after 2 weeks, after 1 month, and then again every 3 months – you may get Liver damage and it needs to be monitored closely.  She normaly only prescribed this when all other methods had failed, but she said I had clearly tried everything else (except phototherapy which she said was very expensive and not effective most of the time for EK).  I decide that I will be 60 in a few years and have had a gutful of EK, I dont drink much anyway, the hair is going anyway, so lets see what happens.

The treatment is/was a combination of several things. Firstly it was a ‘trial’ for two weeks – and then a return visit and a blood test.  Take one 25mg tablet each morning of Neotigason (Acitretin). Apply Salicylic Acid cream to hands once a day for two weeks (in mornings). Apply Dermovate Cream to hands once a day for 2 weeks (at night). And apply ‘Gloves in a Bottle’ 3-4 times a day – both to the hands and feet and also to the skin that is exposed to sun/air (face, neck, legs, arms).  And dont drink any alcohol at all – and avoid direct sun on the skin at all costs – for two weeks. And if the eysight gets bad to stop and come back.

After two weeks the hands had been through the strip and heal process and are starting to look good. But I am having headaches and the eyesight is blurry for a few hours after taking the pill in the mornings, plus feeling nasuea now and then, and the hair has started to fall a little.  After seeing the doctor and the blood test for liver (all good) the treatment changes to the following for the next 2 weeks.   One 10mg tablet each morning of Neotigason and one 10mg tablet at night.  No more Salicylic Acid cream – it has done it job (stripped away bad skin).  Dermovate Cream to hands very thinly every second-third day. And apply ‘Gloves in a Bottle’ 3-4 times a day. And still dont drink any alcohol at all – and avoid direct sun on the skin.

After the next two weeks (1 month) the hands were great - absolutely no EK.  After 3-4 days the headaches had gone, and the eyesight is only a little blurry at night when driving (more sensitive to headlights than before but AOK). No more feelings of nasuea after 2-3 days. The 2 x 10mg was the trick.  But the hair is continuing to fall a little – who cares.   I again then see the Doctor and have another blood test for liver (all good).  The treatment now changes to the following for the next month.   One 10mg tablet each morning of Neotigason and one 10mg tablet at night.  No more Salicylic Acid cream. Dermovate Cream for 2-3 nights only if/when EK breaks out (does a little now and then). Apply ‘Gloves in a Bottle’ 3-4 times a day.  And I get blood tests every 3-4 months to make sure Liver OK – clearly people drinking too much in their lives (or who have had any Liver diseases/problems) should not take Neotigason.

(see part 3)
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Avatar universal

Is the gluten free diet still working for you and your EK?
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Hello all

I have come to this board and also posted in regards to my exfoliative keratolysis. To summarize, I am a Registered Nurse, and always thought it was related to my frequent glove use and hand washing. It turned out I was allergic to the dye in the gloves at work (blue dye), so they switched me to clear gloves. After 4 years, I still have the same cycling of peeling and rehealing, hardened skin, all painless.  

I started a new diet 2 months ago, and I have eliminated all WHEAT products from my diet. So no bread, pizza, flour, cakes, cookies, pastries, etc.  In just 1 month, my skin stopped peeling. I was really shocked. It turns out the gluten or other component of wheat was causing an inflammatory / allergic process on my hands.

I hope this helps anyone else looking to try something out. The side effect is you will also lose a lot of fat (because wheat spikes insulin which then promotes fat storage). Even if you don't need to lose fat, I suggest trying this.
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1 Comments
I have suffered EK for 40 years.  What greatly helps for me is simply soaking my hands in hot water for about an hour.  Hot bath or hot tub makes it easy.  Soak until skin is "pruny".  Takes a few times, once a day, pretty much until your skin doesn't prune anymore (maybe related). For me, much better results than tons of other nasty treatments from dermatologist (drugs, lotions, tar, etc etc).
Avatar universal
Try Vasoline.  Works great, softens hands, hides blisters, and cures problem in a could weeks.
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Avatar universal
Just wanted to add my feedback on this --

I have suffered from dry skin problems for years and years. After much research I am coming to the conclusion that it is an auto immune condition caused by intestinal permeability. I have had a lot of testing done and confirmed my gut is semi-permeable and contains and overgrowth of fungus (unknown species).

Recently I have come in contact with some fungus/mold while working with some mulch and developed this EK condition the next day. I had never had it before in my life. This correlation further strengthens my suspicious of a sensitivity to fungus and gut dysbiosis. I am pursuing an anti-fungal diet, anti-fungal herbs, intensive therapeutic pro-biotic treatments and the GAPS diet to heal my gut. This won't be easy but I have decent evidence it is the source of the problem. I'm not interested in temporary fixes but want to get to the root cause.

This may not be the case with everyone (fungal overgrowth) but I suspect that guy dysbiosis is the root for many sufferers of EK and I believe GAPS is the most effective way of healing for this. It is worth looking into.
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