What are the causes of desquamation (peeling skin) on the hands?

From the Guidelines

Peeling skin on hands is most commonly caused by dry skin, contact dermatitis, and excessive hand washing, which can be exacerbated by the use of certain antiseptic agents and hand hygiene products, as reported in 1 and 1. The causes of peeling skin on hands can be multifaceted, including:

• Dry skin, which is the most common cause, especially in cold or low-humidity environments
• Contact dermatitis, which occurs when hands are exposed to irritants like soaps, detergents, or chemicals
• Eczema and psoriasis, which are chronic skin conditions that can cause inflammation and peeling
• Fungal infections, such as athlete's foot, which can spread to hands and cause peeling
• Sunburn, which damages skin cells and leads to peeling as the skin heals
• Allergic reactions to products or foods, which can trigger skin peeling
• Frequent hand washing or sanitizing, which strips natural oils from the skin
• Certain medications, particularly retinoids, which can cause skin peeling as a side effect

According to 1, antiseptic agents like alcohols, iodophors, and chlorhexidine can cause dryness and irritation of the skin, leading to peeling. Additionally, 1 reports that allergic reactions to hand hygiene products, including fragrances and preservatives, can also contribute to peeling skin on hands.

To prevent or minimize skin dryness and irritation, using lotions or creams is recommended, as stated in 1. Acceptable lotions or creams to use include those containing ingredients like ceramides, urea, or lactic acid. Applying these products regularly, especially after hand washing or sanitizing, can help maintain hand skin health and prevent peeling. For severe cases, a dermatologist may prescribe medicated creams containing corticosteroids or antifungals, depending on the diagnosis.

From the Research

Causes of Peeling Skin on Hands

• Peeling skin on hands can be caused by various factors, including eczema, which is a heterogeneous, fluctuating, and long-lasting disease affecting the hands and wrists 2
• Chronic hand eczema can substantially affect quality of life and may require systemic treatment if topical corticosteroids are unsatisfactory 2
• Other forms of dermatitis, such as atopic dermatitis, irritant and allergic contact dermatitis, and hand dermatitis, can also cause peeling skin on hands 3
• The use of topical corticosteroids, which are a common treatment for eczema, can also lead to local adverse events, including abnormal skin thinning, especially with higher-potency corticosteroids 4

Treatment Options

• Topical corticosteroids are a first-line treatment for eczema, but their optimal use is still uncertain 4
• Proactive therapy with twice weekly use of topical corticosteroids can help prevent eczema relapse (flare-ups) 4
• Other treatment options for eczema include moisturizers, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications, including biologics 3, 5
• The treatment of eczema should aim to restore the function of the epidermal barrier and reduce skin inflammation, and may involve a combination of these treatment options 5

Disease Severity and Quality of Life

• Atopic dermatitis (AD) can have a significant impact on quality of life, similar to psoriasis 6
• The guidelines for AD management may be less aggressive than those for psoriasis, but it is important to consider rapid advancement to systemic agents in AD management, especially with the development of new and better agents 6