Keratolysis Exfoliativa and the Mosaic Fungus

Keratolysis exfoliativa (dyshidrosis lamellosa sicca): a distinct peeling entity

“…3,4,6 In the more severe cases, multiple lesions coalesce and this may result in superficial peeling of the entire surface of the palmoplantar skin. 7,8 Subjective symptoms are rare, 5,6,8 although the skin can be sensitive when it becomes thin from successive peeling. 9,10 The condition worsens in warm weather and patients often present with palmar and ⁄or plantar hyperhidrosis.…”

“…11,12 Moreover, it has been proposed that KE is a fungal infection 3 or a dermatophytid reaction caused by interdigital dermatomycosis of the feet. 8 KE clinically also resembles acral peeling skin syndrome (APSS), which is characterized by superficial exfoliation on the volar and dorsal aspects of the hands and feet, caused by mutations in the TGM5 gene. 13 In addition, epidermolysis bullosa simplex (EBS) of the hands and feet caused by mutations in either KRT5 or KRT14 and characterized by fluid-filled blisters on the volar and dorsal aspects of the hands and feet can be mistaken for KE.…”

“…Typically it starts with an annular erythema with an air‐filled blister arising in the centre, followed by superficial collarette and lamellar peeling 3,4,6 . In the more severe cases, multiple lesions coalesce and this may result in superficial peeling of the entire surface of the palmoplantar skin 7,8 …”

“…Subjective symptoms are rare, 5,6,8 although the skin can be sensitive when it becomes thin from successive peeling 9,10 . The condition worsens in warm weather and patients often present with palmar and/or plantar hyperhidrosis 9,11 .…”

“…KE has been regarded as a subtype of acrovesicular dermatitis or dyshidrotic eczema and associated with atopy 11,12 . Moreover, it has been proposed that KE is a fungal infection 3 or a dermatophytid reaction caused by interdigital dermatomycosis of the feet 8 . KE clinically also resembles acral peeling skin syndrome (APSS), which is characterized by superficial exfoliation on the volar and dorsal aspects of the hands and feet, caused by mutations in the TGM5 gene 13 .…”