PA Medical News about Dermatitis, Exfoliative

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Enlarging vesicular peeling of the palms
The Clinical Advisor, 11/03/09

Cohen PR – A 19–year–old African–American man came to the clinic for the evaluation of asymptomatic peeling on his palms. The condition developed after the patient had completed a 10–day course of ciprofloxacin 500 mg b.i.d. The peeling had originated on the tips of his thumbs and fingers and progressed to his palms. The first signs of disease were superficial, pinhead–sized, white macules that progressed to empty vesicles with dry, flaccid, paper–thin roofs. As the lesions enlarged, the central portions would rupture; the edges would become ragged as the roof peeled away. New lesions continued to appear, and there was coalescence of enlarging older lesions...The patient was diagnosed with keratolysis exfoliativa, a relatively common, asymptomatic, noninflammatory, idiopathic keratolytic disorder. Keratolysis exfoliativa is a self–limited condition. Topical treatment with an emollient cream can be helpful for managing the dryness and for expediting resolution of the scaling. Often, the cream that is used contains a keratolytic agent, such as a–hydroxy acid, salicylic acid, tretinoin, or urea. This patient was advised to start twice–daily topical treatment with an OTC emollient (Eucerin cream). Prompt improvement, manifested as diminished peripheral scaling, was seen within two days after beginning treatment. The peeling resolved completely after one week of therapy.