A 30 year old man in the summer comes to you with this for 2 months, It is not itchy nor does he note vesicles. He moisturizes but says it doesn't help.

KERATOLYSIS EXFOLIATIVA

Keratolysis exfoliativa (KE) is an uncommon, benign, scaly condition in which ringed collarettes of scale develop on the palms. The term ringed keratolysis has also been used. The patient is usually a young adult and the condition is most common in the summer. No bacterial or fungal agent has been found.

Clinical

Initially, a small bubble or small white ring on the palm may be seen. The lesion then evolves into a collarette of scale without significant erythema.

Keratolysis Exfoliativa or Pompholyx?

1. KE is not pruritic and not vesicular. Pompholyx presents with tapioca-like vesicles on the sides of the fingers, palms and occasionally soles.

Treatment

Emollients are usually not helpful. One may try keratolytics. As this may be a forme fruste of irritant hand dermatitis, a topical steroid may be tried. One patient of mine got significant suppression of her disease with oral erythromycin.

RegionalDerm

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