Loosely translated, exfoliative keratolysis (EK) refers to an exfoliation of the top layer of the skin, the epidermis. 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 skin waterproof. When the keratin breaks down, the skin loses its strength and begins to shed, or exfoliate. Exfoliative keratolysis can also be called “focal palmar peeling” or “keratolysis exfoliativa.” In generic terms it’s known as the “skin peeling disease.”

One big problem with EK is that sufferers often delay a doctor’s visit because the condition is not usually painful. At first, EK can be mistaken for a simple case of dry skin. Another problem is that when sufferers do finally visit a doctor, the condition is easy to misdiagnose. Hai Lam, an EK sufferer from Corinth, Texas, says he’s had both a general practitioner and a dermatologist make a diagnosis as “some sort of dermatitis.” The assignment of this general diagnosis is easy to understand. EK is often a seasonal conundrum, or the body’s response to acute stress or an allergen, which means its appearance can be sporadic and inconsistent. 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. There is no known cure for EK, though there are seasons where the condition is dormant.

In EK’s 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 elements and irritants: water, sun, detergents, etc.

While the exact cause of EK is unknown, a variety of factors are known to 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. The nebulous nature of the factors that cause EK leave sufferers attempting to figure out the best way to avoid exposure to irritants, while at the same time trying to implement a treatment plan to heal the skin.

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 cleansers for the body, hair, and cleaning supplies. But even the best preventative measures may not be enough. In the event of an outbreak, it’s time to treat the skin that is peeling. The agreed upon 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 cream. Dr. Jodi S. Politz, D.P.M., at Mountain Podiatry in Las Vegas says she recommends Vanos, “the strongest cortisone cream on the market.” She also says “high doses of prednisone can be helpful if all other products do not help.” Because EK is not usually painful and can go dormant, many sufferers opt out of steroid treatments, which can have adverse side effects. Even when patients are willing to take the risk, the result can be disappointing. Doctors have also begun to use photo chemotherapy to treat EK, but results are inconclusive. 

WHAT’S A TECH TO DO?

The good news is that 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 their nails 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, which will do a lot toward making a client feel better about herself and her hands. 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. Recommend the client use a moisturizer with urea four to six times a day. Techs can also suggest clients apply the moisturizer under cotton gloves at night, but a tech’s main responsibility is to protect the client from exposure to irritants while she is the salon.

The important thing to relay to clients with EK is that only a consistent treatment strategy will produce positive results. Occasional application of moisturizer will do little to heal the skin. Aggressive, proactive attention is required if clients want to treat EK successfully. A nail tech can recommend over-the-counter treatments or a visit to a doctor, but there is little else she can do.