From the Guidelines
The workup for a patient presenting with peeling skin of the hands should begin with a thorough history and physical examination to determine the underlying cause, with a focus on identifying potential irritants or allergens, as recommended by the American Contact Dermatitis Society 1. The initial step in evaluating a patient with peeling skin of the hands is to take a detailed history, including:
- Onset and duration of symptoms
- Associated symptoms like itching or pain
- Exposure to potential irritants or allergens
- Occupational factors
- Recent medication changes
- Personal or family history of skin conditions Physical examination should assess the pattern and extent of peeling, presence of erythema, vesicles, or fissures, and involvement of other body areas.
Initial diagnostic steps may include:
- Potassium hydroxide (KOH) preparation to rule out fungal infections
- Patch testing if contact dermatitis is suspected
- For persistent cases, a 4mm punch biopsy may be necessary Laboratory tests might include:
- Complete blood count
- Metabolic panel
- Specific antibody tests if an autoimmune condition is suspected Common causes of hand peeling include:
- Irritant or allergic contact dermatitis
- Atopic dermatitis
- Psoriasis
- Fungal infections like tinea manuum
- Dyshidrotic eczema
- Exfoliative keratolysis Treatment depends on the underlying cause but often includes:
- Avoiding irritants
- Using gentle soap-free cleansers
- Applying moisturizers containing ceramides or petrolatum several times daily
- Using topical corticosteroids like triamcinolone 0.1% ointment twice daily for 1-2 weeks for inflammatory conditions
- For fungal infections, antifungal creams like clotrimazole or terbinafine applied twice daily for 2-4 weeks are typically effective Patients should be advised to:
- Wear protective gloves for wet work
- Avoid hot water
- Maintain good skin hydration to prevent recurrence, as suggested by the American Contact Dermatitis Society 1.
From the Research
Workup for Peeling Skin of the Hands
The workup for a patient presenting with peeling skin of the hands involves a thorough dermatological assessment, including history-taking and examination 2. The following steps can be taken:
- Obtain a detailed medical history to identify potential causes of peeling skin, such as exposure to irritants, allergic reactions, or underlying skin conditions like psoriasis or atopic dermatitis.
- Perform a physical examination to assess the extent and characteristics of the peeling skin, as well as to check for any other skin lesions or abnormalities.
- Consider laboratory tests, such as skin scrapings or biopsies, to rule out infectious or inflammatory causes of peeling skin.
- Evaluate the patient's symptoms and medical history to determine the best course of treatment, which may include topical corticosteroids or other medications.
Potential Causes and Treatments
Peeling skin of the hands can be caused by a variety of factors, including:
- Dermatomycoses, which are contagious superficial fungal infections that can be treated with topical antifungal agents and corticosteroids 3.
- Inflammatory skin conditions, such as psoriasis or atopic dermatitis, which can be treated with topical corticosteroids 4.
- Other conditions, such as carcinoid syndrome or pheochromocytoma, which may require further laboratory or radiologic studies to diagnose and treat 5.
Additional Considerations
When treating peeling skin of the hands, it is essential to consider the potential effects of topical corticosteroids on the skin, including the risk of adverse effects such as atrophy, striae, and rosacea 4. Additionally, the metabolism of hydrocortisone by Staphylococcus aureus can influence the anti-inflammatory and antimicrobial action of topical corticosteroids 6.