Differential Diagnosis for Peeling Skin on Hands

• Single most likely diagnosis
  • Keratolysis exfoliativa: A common condition characterized by peeling of the skin on the palms, often due to excessive moisture, friction, or exposure to certain chemicals. It's usually benign and self-limiting.
• Other Likely diagnoses
  • Eczema (Dyshidrotic): A type of eczema that causes small blisters on the hands, which can lead to peeling skin as they heal. It's often associated with stress, allergies, or exposure to certain metals.
  • Psoriasis: An autoimmune condition that can cause thick, scaly patches on the skin, including the hands. Peeling skin can occur as the scales flake off.
  • Contact dermatitis: A skin reaction that occurs after contact with an irritant or allergen, leading to redness, itching, and peeling skin on the hands.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Toxic epidermal necrolysis (TEN): A life-threatening condition that causes widespread skin peeling, often due to a severe allergic reaction to medications. Early recognition and treatment are crucial to prevent mortality.
  • Staphylococcal scalded skin syndrome (SSSS): A rare but serious condition caused by staphylococcal toxins, leading to widespread skin peeling and potentially life-threatening complications.
• Rare diagnoses
  • Kawasaki disease: A rare condition that affects children, causing fever, rash, and peeling skin on the hands and feet.
  • Pemphigus: A group of rare autoimmune diseases that cause blistering and peeling skin, which can affect the hands.
  • Acral peeling skin syndrome: A rare genetic disorder that causes recurrent peeling of the skin on the hands and feet.