Differential Diagnosis for Peeling Skin on Palms

• Single most likely diagnosis
  • Keratolysis exfoliativa: A common condition characterized by recurrent episodes of peeling of the skin on the palms, often associated with excessive sweating, heat, or friction. It's usually benign and self-limiting.
• Other Likely diagnoses
  • Eczema (dyshidrotic): A type of eczema that affects the palms, causing small blisters and peeling skin, often accompanied by itching and burning sensations.
  • Psoriasis: A chronic skin condition that can cause peeling skin on the palms, along with redness, scaling, and thickening of the skin.
  • Contact dermatitis: A skin reaction that occurs after contact with an irritant or allergen, leading to peeling skin, redness, and itching on the palms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Kawasaki disease: A rare condition that mainly affects children, causing peeling skin on the palms and soles, along with fever, rash, and lymph node swelling. If left untreated, it can lead to serious cardiac complications.
  • Toxic epidermal necrolysis (TEN): A life-threatening skin condition usually triggered by medications, causing widespread skin peeling, including on the palms, and requiring immediate medical attention.
• Rare diagnoses
  • Pemphigus: A group of rare autoimmune diseases that cause blistering of the skin, including peeling skin on the palms, and can be life-threatening if not treated promptly.
  • Acral peeling skin syndrome: A rare genetic disorder characterized by recurrent episodes of peeling skin on the palms and soles, often starting in childhood.