If your hands develop tiny superficial, air-filled blisters that burst and leave behind circular areas of peeling skin, particularly during warmer weather or if your palms sweat easily, the cause may be keratolysis exfoliativa. It is commonly mistaken for eczema, psoriasis or a fungal infection.
Keratolysis exfoliativa is a benign condition in which the outermost layer of the skin separates prematurely. The exact cause is not fully understood, but heat, sweating and friction are common triggers.
The good news is that it is harmless and management focuses on protecting the skin barrier. Use gentle cleansers, avoid harsh soaps and detergents, and apply rich hand creams containing ingredients such as urea or lactic acid.
Unlike eczema, topical steroids generally do not help, which can be an important clue to the diagnosis. If the peeling is severe, persistent or keeps recurring, it is worth seeing a dermatologist to confirm the diagnosis and discuss further treatment options.
What is keratolysis exfoliativa?
Keratolysis exfoliativa is a benign, non-infectious condition that causes recurrent superficial peeling of the palms and, less commonly, the soles. Unlike eczema, it usually causes little or no itching or inflammation.
Typical presentation:
- It often begins with very superficial, air-filled blisters that quickly rupture.
- These leave behind circular or ring-shaped areas of peeling skin, which can be mistaken for simple dryness, eczema or a fungal infection.
- Keratolysis exfoliativa is considered a distinct condition rather than a form of dyshidrotic eczema. A 2012 study in the British Journal of Dermatology helped characterise its clinical and microscopic features as a separate diagnosis.
- The peeling often settles spontaneously over several weeks, but recurrence is common, particularly during warmer weather or in people with sweaty palms.
It is also sometimes referred to as exfoliative keratolysis or focal palmar peeling.
What causes keratolysis exfoliativa?
The exact cause of keratolysis exfoliativa is not fully understood, but it is strongly associated with sweating, heat, friction and repeated exposure to water or irritants.
Skin cells in the outermost layer of the skin, the stratum corneum, are normally held together until they are ready to shed. In keratolysis exfoliativa, these connections appear to break down prematurely, causing the superficial layer of skin to separate and peel away in sheets or rings.
The condition is commonly seen in people with sweaty palms (hyperhidrosis) and tends to flare during warmer weather. Friction and prolonged moisture exposure can also contribute, and it has historically been described in people whose hands were frequently exposed to water.
Frequent contact with soaps, detergents, solvents and repeated hand washing can make the peeling worse by further disrupting an already fragile outer skin layer.
Importantly, keratolysis exfoliativa is not contagious, is not caused by a fungal infection and is not an allergic reaction.
Is it eczema, psoriasis, or a fungal infection?
These conditions can sometimes look similar, so getting the correct diagnosis is important because the treatments are very different.
Eczema including pompholyx, or dyshidrotic eczema, often causes itching, redness and inflammation, sometimes with small fluid-filled blisters or weeping skin. Keratolysis exfoliativa, by contrast, is usually much less itchy and inflamed and is characterised mainly by superficial peeling. Dr Phillips explains eczema on the hands here.
Psoriasis usually causes thicker, more sharply defined areas of scale and may also be present at other typical sites such as the elbows, knees or scalp.
Fungal infection of the hand, known as tinea manuum, can sometimes mimic these conditions. It is often more prominent on one hand and may be associated with fungal infection of the feet or nails. If there is any doubt, a skin scraping can be taken to look for fungal infection.
Another useful clue is response to treatment. Topical corticosteroids, which are commonly used for eczema, generally do not help keratolysis exfoliativa. If repeated courses of steroid cream have made little difference to peeling hands, that is worth mentioning to your dermatologist.
In most cases the diagnosis can be made from the appearance of the skin and the history. Occasionally, further tests such as fungal sampling or, much less commonly, a skin biopsy may be needed if the diagnosis remains uncertain.
How is keratolysis exfoliativa treated?
Treatment is relatively simple and focuses on protecting the skin barrier, reducing exposure to triggers and keeping the hands well moisturised.
Switch to a gentle, fragrance-free cleanser rather than harsh soaps or antibacterial hand washes, which can further disrupt the already fragile outer layer of the skin. Apply a rich hand cream regularly, particularly after washing your hands. Creams containing ingredients such as urea or lactic acid can help soften and hydrate areas of peeling skin.
Where possible, reduce prolonged contact with water, detergents and solvents. Wearing cotton-lined protective gloves for washing up, cleaning or other wet work can help minimise irritation.
Avoid picking or peeling loose skin, as this can cause further irritation and occasionally lead to secondary infection.
Topical corticosteroids, which are commonly used to treat hand eczema, generally do not improve keratolysis exfoliativa. In severe or frequently recurring cases, a dermatologist can confirm the diagnosis and discuss whether additional treatment is appropriate.
The practical takeaway: focus on gentle hand care, regular moisturising and reducing exposure to water and irritants. Keratolysis exfoliativa is harmless, but it can recur, particularly if sweating, heat or friction continue to trigger it.
When should I see a dermatologist about peeling hands?
- If the peeling keeps recurring, does not improve after several weeks of gentle skin care and regular moisturising, or becomes severe enough to crack, bleed or become painful.
- If you are not sure whether the cause is keratolysis exfoliativa and want to rule out eczema, psoriasis, a fungal infection or another skin condition.
- If the rash is spreading, becoming markedly asymmetrical, or is associated with nail changes.
- If you find yourself repeatedly picking or pulling at the peeling skin and are struggling to stop.
Book a consultation with Dr Derrick Phillips in London for a specialist assessment if persistent or recurrent hand peeling is not settling with basic skin care.
Questions Asked in Clinic
Is keratolysis exfoliativa contagious?
No. Keratolysis exfoliativa is not caused by a bacterial or fungal infection, so it cannot be passed from one person to another through contact.
Why do my hands only peel in summer?
Heat and sweating are common triggers, which is why keratolysis exfoliativa often flares or recurs during warmer months, particularly in people who are prone to sweaty palms.
Why isn’t moisturiser helping my peeling hands?
A light hand lotion may not be enough if the skin is repeatedly peeling. Richer creams containing ingredients such as urea or lactic acid can help soften and hydrate the affected skin and are usually more useful when applied regularly, particularly after hand washing. If several weeks of consistent skin care makes little difference, it is worth having the diagnosis reviewed, as persistent peeling may have another cause.
Can stress cause peeling hands?
Stress is not considered a direct cause of keratolysis exfoliativa, but it can increase sweating in some people, which may aggravate the condition. Repeated picking or peeling of loose skin can also make the hands more irritated and delay recovery.
Does keratolysis exfoliativa ever go away permanently?
It often settles with appropriate skin care and may disappear completely between episodes, but recurrence is common, particularly during warmer weather or periods of increased sweating. There is no single treatment that permanently prevents it, but most people can manage the condition effectively by protecting the skin barrier and reducing known triggers.
Author: Dr Derrick Phillips, Consultant Dermatologist, MBBS BSc (HONS) FRCP (Dermatology)
Last reviewed: September 2026