What are the causes of peeling skin on hands and feet?

What are the causes of peeling skin on hands and feet?

Q: My 87-year-old father's skin is very sensitive and appears to be very thin. Earlier this year, the skin on his feet and hands started to peel, which caused him much pain.

The worst hit were his fingertips, so much so that he found it painful to hold an object. He saw a skin specialist but the problem persists, even though he uses moisturisers.

From what you have described, the condition is suggestive of hand and foot eczema. This is a common skin condition and can be very distressing.

In severe cases, deep fissures (grooves) may develop, which can be very painful.

As the condition is chronic, it may be beneficial for your father to be evaluated for underlying accompanying irritant or allergic contact dermatitis and contact urticaria (hives) with a patch test and a skin prick test.

Contact dermatitis is a condition in which the skin becomes red, sore or inflamed after direct contact with a substance. In contact urticaria, the skin becomes red and sore immediately after contact with a substance, rather than within hours or days.

It would also be good to exclude underlying infections that may aggravate or retard healing.

In general, minimising handwashing and contact with water and using moisturisers frequently would be essential.

Avoid using harsh soaps and identified substances that cause an allergic reaction.

Treating underlying infections, if any, would also alleviate his condition.

For his painful lesions, an antibiotic ointment may be beneficial. Topical steroids should be used judiciously. I would recommend these only if there are thick plaques or itchy vesicular (small, bubble-like) rashes.

Your father does not seem to be complaining of itch and you mentioned his skin appears thin. So he may not need topical steroids.

In recalcitrant severe hand and feet eczema, phototherapy or oral immunosuppressants may be considered. A skin biopsy (test of skin cells) may be needed.

Do see your dermatologist for further evaluation and advice.

Dr Raymond Kwah
Consultant dermatologist at Raffles Skin & Aesthetics Centre at Raffles Hospital

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