Differential Diagnosis for a 12-year-old Male with Hands Peeling

• Single most likely diagnosis:
  • Keratolysis exfoliativa: A common, benign condition characterized by the peeling of the skin on the palms, often seen in children and adolescents. It is usually asymptomatic and resolves on its own.
• Other Likely diagnoses:
  • Eczema (atopic dermatitis): A chronic skin condition that can cause dryness, itching, and peeling, especially on the hands.
  • Contact dermatitis: An allergic or irritant reaction to substances that come into contact with the skin, leading to inflammation, itching, and peeling.
  • Psoriasis: An autoimmune condition that can cause thick, scaly, or peeling skin patches, including on the hands.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Toxic epidermal necrolysis (TEN): A severe skin condition, usually triggered by medications, that can cause widespread skin peeling and detachment, which can be life-threatening if not promptly treated.
  • Staphylococcal scalded skin syndrome (SSSS): A condition caused by staphylococcal toxins that can lead to widespread skin peeling, especially in children, and requires immediate medical attention.
• Rare diagnoses:
  • Pemphigus: A group of autoimmune diseases that can cause blistering and peeling of the skin, including on the hands.
  • Kawasaki disease: A rare condition that mainly affects children, causing fever, rash, and peeling of the skin on the hands and feet, among other symptoms.
  • Nutritional deficiencies (e.g., zinc or biotin deficiency): Certain nutritional deficiencies can lead to skin peeling and other dermatological symptoms.