Nail & Skin Disorders

Under the Microscope: Exfoliative Keratolysis

Exfoliative keratolysis is a condition where the top layer of the skin perpetually peels due to a breakdown in the keratin that forms the epidermal tissue.

What is it? Exfoliative keratolysis (EK) refers to an exfoliation of the top layer of the epidermis (the skin). The epidermis, while being the outermost layer of skin, is itself made up of multiple layers. These layers are made of keratin, a protein that gives skin its strength and flexibility and makes it waterproof. When the keratin breaks down, the skin loses its strength and begins to shed, or exfoliate. In its earliest stages, small, air-filled blisters appear on the skin. As the condition worsens, the air pockets break open, removing the epidermis, which acts as protective barrier. The compromised skin is now exposed to and unprotected from the elements and irritants, such as water, sun, and detergents.

How do you get it? While the exact cause of EK is unknown, a variety of factors can contribute to an outbreak. In some cases people are predisposed to EK because of family genetics. Others find that outside factors converge, creating the perfect environment for EK to develop. Those factors include a weakened immune system, stress, allergies, irritants, and temperature change. Young adults are more prone to develop EK than any other age group. EK is often a seasonal problem, or the body’s response to acute stress or an allergen, which means its appearance can be sporadic and inconsistent.

How is it treated? It’s not easy to find a treatment plan that works, because the response to EK treatments varies from person to person. However, some general rules apply. The first treatment is always prevention: avoid all soaps, detergents, or solvents that could irritate the skin. Choose hypoallergenic products for the body, hair, and cleaning supplies. In the event of an outbreak, treat the peeling skin. The first step in terms of over-the-counter treatments is to find a moisturizer that contains urea. If the over-the-counter treatments don’t work, a prescription may be in order. Doctors can prescribe a number of medications, including topical steroids and cortisone creams.

What can a tech do? EK is not in any way contagious, so techs do not have to fear touching and serving clients with EK. However, techs may need to alter their products for clients with EK, avoiding a fragranced moisturizer, for example, or by having hypoallergenic hand soap available for client use. In addition, clients who have nail enhancements may need to have them removed, depending on the severity of the outbreak. Exposure to nail products could irritate the skin unnecessarily. Techs can still offer natural nail services to clients. If a client has a particularly severe outbreak of EK, techs may want to avoid polishing the nails and instead offer to buff them to a high shine. Avoid trying to slough, exfoliate, or buff the dry skin off the palms of the hands and the bottom of the feet. This will irritate rather than aid the condition.

What else? Because it’s possible for EK to appear on the hands and heal in a few weeks, many sufferers don’t realize they are dealing with a life-long problem until multiple EK outbreaks have appeared and healed. It could take a number of months or even years before sufferers and doctors consider the diagnosis of exfoliative keratolysis.



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