Exfoliative keratolysis

　　The etiology is not yet clear, and it may be an autosomal recessive genetic disease. Some believe that it is related to dysfunction of sweating and autonomic nervous system disorder. This disease often occurs concurrently with pompholyx. The pathogenesis is not yet clear, and some scholars believe it is a disease of keratin layer adhesion disorder.

　　This disease mainly affects the palm and sole, occasionally also seen on the dorsal side of the hand and foot, with symmetrical distribution. The initial skin lesions are pinpoint white spots, formed by the separation of the epidermal keratin layer and the underlying layer, without inflammatory changes. They gradually expand to the periphery, resembling the membrane of dried vesicle fluid, which is prone to spontaneous rupture or tearing into thin paper-like scales. The skin below is normal. The skin lesions continue to expand, new scales form, and eventually fuse into a whole sheet of scaly lesions that can be peeled off without itching. This disease is prone to recurrence in warm and hot seasons, often accompanied by local hyperhidrosis.

　　The skin lesions begin as pinpoint scattered white vesicles, the number of which is not fixed, gradually expanding outward, with central rupture forming superficial desquamation. Most skin lesions can expand and fuse into a thin paper-like epidermal desquamation. The skin underneath the desquamated epidermis is almost completely normal, lacking inflammatory signs. It often occurs symmetrically on the palms and soles. The course is slow, without自觉 symptoms, and the scales naturally fall off and heal after about 2-3 weeks. The disease usually starts at the end of spring and the beginning of summer, and the symptoms can spontaneously alleviate when the autumn climate turns cool, more common in adults.

　　Keratolysis exfoliativa can severely affect the daily life of patients, so it should be actively prevented. During prevention, attention should be paid to avoid contact with irritant chemical products such as soap and hand sanitizer, and it can heal spontaneously after 2-3 weeks.

　　Patients with keratolysis exfoliativa generally do not need to be examined. Diagnosis is not difficult based on the characteristics of the skin lesions, which only have scales without blisters and inflammatory changes, without itching, and the distribution of the lesions. Children with the disease can undergo trace element examinations.

　　There is a certain relationship between abnormal skin keratin and the deficiency of zinc and vitamin A. Once a child shows symptoms of peeling of the hands and feet, a trace element examination should be performed, and zinc should be supplemented in time if deficient. In daily life, children can also be encouraged to eat more foods rich in vitamin A, such as egg yolks, pork liver, carrots, spinach, oranges, tomatoes, etc., and try to drink more water to alleviate the lack of body water caused by dry weather.

　　The treatment of keratolysis is relatively simple, and it can be locally applied with urea ointment or vitamin E ointment, vaseline ointment, and other oily ointments on the skin with cracked and peeled skin. The former can soften the stratum corneum, and the latter can play a role in moisturizing and protecting. It should also be frequently applied after healing as a hand care routine.