Exfoliative keratolysis

I wondered if anyone has experience of exfoliative keratolysis, also known as focal palmar peeling?

When I was extremely hypo the skin on my feet and hands got very, very dry, thick and yellow like leather, and then began peeling off in sheets. Underneath skin would be pink and sore until it dried out after a few weeks. Then the process would repeat.

Now that I am on T4+T3 I have found all my thyroid symptoms have improved (no longer tired, dizzy, cold, panicked, palpitations etc). I am almost back to normal now. But the skin on my fingers never seems to have recovered. The palm-side skin on my finger tips constantly dries out, forms tiny white air-filled blisters, and then slowly peels off. The process takes about two weeks, then just repeats. There is no response to steroid creams and it is not itchy.

Having done a lot of reading now, I am starting to suspect this may actually be a different skin condition - exfoliative keratolysis - rather than directly caused by thyroid hormone imbalance. I have read it can be triggered by stress (definitely had a lot of that this year) and autoimmune diseases (I have Hashimoto's).

If anyone else has had this I'd be grateful to know if your symptoms seemed similar?

12 Replies

  • As an update - the only treatments I have found give me any relief are one particular Eucerin hand cream with 10% urea and lactate, and Cerave moisturiser with ceramides and niacinamide. These keep my skin feeling soft and flexible, although I have to apply throughout the day and I still get the peeling.

  • I may be barking up the wrong tree here, but does this match your symptoms?


    Look for pictures of dyshidrosis on Google Images - be prepared for horrible pictures!

  • No, it doesn't look like that at all. The blisters also have no fluid inside whatsoever. I guess blister is not quite the right word to describe them but I don't know how else, just tiny patches of skin go white and seem to separate from the layers below...then the peeling starts. It really does look like the pictures of exfoliative keratolysis but I kind of hope it's something else, as there doesn't seem to be a treatment for it.

  • Oh well, I knew it was a long shot, but thought it was worth a try. :) Good luck with finding something which helps.

    I have dyshidrosis, and I have found that getting some of my vitamins and minerals up to optimal levels has helped reduce the severity of it as well as reducing the frequency and length of attacks. I just wish I could afford to test more minerals and vitamins - there are quite a few of the major ones I've still never had tested.

  • I get that on my feet. I'm Hashi too. I've had it as far back as I can remember and have only recently been diagnosed with a thyroid problem. Reading your post is the first time it occured to me that the two could be connected!

  • I too am Hashi's and am currently going through, what has become an annual event although it usually happens in the spring. As you say, it starts with tiny air filled blisters which pop and then start peeling outwards. In my case they turn into what can only be described as a 'burn'. Very painful resulting in the sort of 'healing over' one would expect if you'd burned yourself with hot oil or something similar. I have found that applying the sap from a torn off bit of Aloe Vera plant and then covering it with a plaster for 24 hours works very well in 7 out of 10 cases. In the other 3 I just have to wait for the 'burn' to heal in its own good time. To keep the hands soft I find E45 Intense Recovery hand cream quite useful, but as you say, it needs to be applied every time you wash your hands and at over £4 for a small tube that can become quite expensive. Vaseline or petroleum jelly (if you can stand the smell) is also a useful alternative ointment.

  • Sorry to say that I am in the throes of this same condition. I am using Burt's Bees Hand Salve with some success, but only to relieve the symptoms. I could list the 20 or so creams, lotions and salves I have tried, but they only help marginally and for a short time. I can't seem to find a doctor who can diagnose it, however, my animal pathologist daughter called it exfoliative kerotolysis immediately. I take a very low dose of levothyroxine, so I appreciated knowing that there may be a link to Hoshimoto and I'll be seeing an Endocrinologist next week and will update if and when I get any additional information or find relief.

  • It's good to know I'm not the only one, although I'm sorry you have to suffer this too. I'm actually in a period of 'remission' at the moment - my hands are dry and I have to moisturise a few times a day, but no blistering or peeling! Hoping they'll stay like this for a while...

  • I also have Hashimotos Disease - right thyroidectomy at 29 yrs old. taking synthroid .150mg.......at 50 yrs old my ovaries and a massive ovarian brenners tumor was removed. About 1.5 months later I got palm blisters. At 55 I was diagnosed with this exfoliative keratolysis. Had a biopsy done. The blisters seem to come back when I eat chicken eggs and flour tortillas. I show no allergies for either thru allergy testing. However, I know that I'm allergic to sulfa drugs. Ive been doing some research on this EK skin condition. Some say take lots of vitamins and minerals, escpeically magnesium. There are some steroid creams which I think helped me - clobe?? sp. I have also taken the homeopathic remedy - calcarea sulfuric, which also helps. Staying away from eggs and flour tortillas also helps ;) Once you have an autoimmune disease, your susceptible to others. chin up!

  • The condition that you are describing is exfoliative keratolysis. I have it. I have no thyroid issues, so this may not be related to that. My condition worsens in the summer when I am exposed to pyrethrin (fly sprays). I manage a horse stable in Colorado, so the exposure is a bit unavoidable :-( I also react this way to bleach and antibacterial soaps. I fare much better in the winter. My hands look so bad from all of the intense peeling that it is embarrassing just have someone hand you your change in a store! They kind of look at you like you have leprosy :-/ They become so raw that they swell at times. Ugggg. If anyone knows any homeopathic cures please let me know!

  • I'm sorry you have this too. Mine has mainly cleared up, I still get it on the index finger and thumb on one hand every so often. It seems to get worse with stress for me, but I do have to be careful with soaps, etc. I find the only thing I can do is layer on a moisturiser that has urea and lactate (Eucerin hand cream + lactate), it's the only thing that keeps the skin moist enough throughout the day.

  • Thank you for the tip! I also read about Kerasal Ultra 20 and thought I might try that. It is "Urea in ammonium lactate cream" I agree about the stress...just having a severe case of this is stressful :-/

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