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Keratolysis exfoliativa
Other Resources UpToDate PubMed

Keratolysis exfoliativa

Contributors: Lauren Mihailides MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Keratolysis exfoliativa (KE), also known as dyshidrosis lamellosa sicca, lamellar dyshidrosis, or recurrent focal palmar peeling, is a common palmoplantar blistering disorder of unknown pathogenesis. The notion that KE represents a mild form of dyshidrotic eczema has been challenged by a recent study of over twenty patients that showed the lack of eczematous features on histopathology.

In KE, annuli of erythema progress to air-filled superficial bullae that rupture to leave fine, expanding collarettes of scale. Bullae may coalesce and lead to desquamation of the entire volar surface; dorsal surfaces are less commonly involved.

While generally asymptomatic, KE can cause a mild, initial burning or tingling sensation and pain upon blister rupture. Chronically, thinning of the skin can cause local sensitivity. Involved surfaces are often associated with hyperhidrosis. Blistering is exacerbated by friction and moist, warm environments.

Codes

ICD10CM:
L26 – Exfoliative dermatitis

SNOMEDCT:
239065004 – Keratolysis exfoliativa

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Other causes of palmoplantar blistering dermatitis:
  • Acral Peeling skin syndrome (linked to mutations in TGM5)
  • Localized Epidermolysis bullosa simplex (linked to mutations in KRT5 or KRT14)
  • Dyshidrotic dermatitis
  • Tinea manusTinea pedis
  • Autoeczematization

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:10/10/2019
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Keratolysis exfoliativa
A medical illustration showing key findings of Keratolysis exfoliativa : Desquamation, Erythema, Flaccid bullae, Hands and/or feet, Palms and soles, Symmetric extremities distribution
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