Skin Peeling: A Healing Step or Reason to Worry?

Peeling skin, also known as desquamation, can occur for a number of reasons, including sun damage, medical conditions, and reactions to irritants or medications. It can happen in a localized area, or be widespread over the body. Peeling skin can have varying levels of severity, from mild and painless, to serious or life threatening.

This article will discuss causes of skin peeling, skin care with skin peeling, when skin peeling is severe, and medical treatment for skin peeling.

Does Skin Peeling Mean Your Skin’s Healing?

Peeling skin is often an indication that your skin is trying to heal from some form of damage. For instance, peeling after a sunburn is your body's way of trying to get rid of damaged cells.

Skin Peeling Causes: Burns, Conditions, and Infections

Peeling skin can happen for a number of reasons, including burns, certain medical conditions and infections, and reactions to irritants or medications.

Sunburn

Ultraviolet radiation from the sun can overwhelm the body's defenses, causing it to react with a sunburn. First-degree sunburns affect only the epidermis (the outermost layer of skin). Second-degree sunburns go deeper to the dermis, and damage nerve endings.

Both degrees of burn can be painful and cause the skin to redden. Second-degree sunburns can also make the skin swell and blister.

Both types of burns can lead to peeling skin, usually about three days after the sunburn occurs.

Peeling Skin Syndrome (PSS)

Peeling skin syndrome is a group of rare, inherited skin disorders. With this condition, the shedding of the outermost layers of skin, that typically happens gradually, is hastened and/or aggravated. This causes painless, continual skin peeling.

Other symptoms may include:

• Blistering
• Reddening of the skin
• Itching

PSS can be divided into categories:

• Generalized inflammatory: Involves the entire body. Associated with reddening and/or blistering of the skin, and involvement of other organ systems
• Generalized noninflammatory: Involves the entire body, but is less severe than inflammatory type
• Localized (acral): Limited to extremities (typically hands and feet)
  

Skin peeling is usually present from birth, but may develop in early childhood or later in life.

Symptoms may be made worse by friction, heat, and humidity or other forms or moisture.

Hand Eczema

Hand eczema, also called hand dermatitis, is a skin condition with symptoms including:

• Dry skin that is cracking, peeling, crusting, flaking, and/or scaly
• Redness
• Itchiness and/or pain in the affected area
  

May be brought on (triggered) by factors such as:

• Genetics
• Contact with allergens or irritating substances
• Working in jobs that expose your hands to chemicals and other irritants, such as cleaning, healthcare, hairdressing, catering, and mechanical jobs
  

Other Health Conditions

Other health conditions associated with skin peeling include:

• Keratolysis exfoliativa: Common, self-limiting condition that presents with small white rings or superficial blisters on the fingers, palms, or occasionally soles of feet, which peel off
  
• Oudtshoorn disease (keratolytic winter erythema): Rare, inherited condition characterized by intermittent and recurrent centrifugal (moves away from the center) skin peeling with skin reddening, particularly on the palms and soles. Occurs during cold, dry climatic periods
• Ichthyoses: Characterized by fixed, orange-red, hyperkeratotic (thickened skin) plaques, most commonly on cheeks, upper trunks, buttocks, extensor surfaces (skin on the outside of a joint), and sometimes palms and soles
• Kawasaki's disease: Acute illness characterized by fever, rash, swelling of the hands and feet, swollen lymph glands in the neck, irritation and redness of the whites of the eyes, and irritation and inflammation of the mouth, lips, and throat; mainly affects children under 5 years old; with peeling of the skin on the of hands and feet occurring two to three weeks after fever onset

Infection

Certain infections or infectious diseases can lead to skin peeling, including:

• Jock itch (tinea cruris): Fungal infection that usually causes a rash (may look circular and have well-defined, elevated edges), and redness, peeling, cracking, or flakiness of the skin in the groin, thigh, or buttocks area; may itch, sting, burn, or feel uncomfortable
  
• Scarlet fever: Caused by Group A Streptococcus (Group A strep) bacteria; characterized by a rough and red rash; brighter red skin in the creases of the underarm, elbow, and groin; pale area around the mouth; and peeling skin in the groin, fingertips, and toes as the rash fades; with peeling that can last up to several weeks
  

Skin Care With Skin Peeling

Caring for peeling skin starts with addressing the cause of the peeling.

For a sunburn, as soon as you notice the burn:

• Keep your skin moisturized.
• Look for products such as aloe vera or a soy-based product.
• Avoid petroleum-based or other oil-based products, which can trap heat and make the burn worse.
• Drink plenty of water to stay hydrated.
• Continue moisturizing when the skin starts to peel, cover peeling skin as it heals, and leave the peeling skin alone to slough off on its own.
• Cover up when outdoors since after a sunburn, skin is more sensitive to additional ultraviolet (UV) ray damage).

For peeling skin syndrome: Apply emollient (skin-softening) ointments, such as Vaseline (petroleum jelly), particularly after a bath.

For hand eczema:

• Identify and avoid irritants that trigger symptoms.
• Wash hands with lukewarm water and fragrance-free cleanser, blot dry, and immediately apply moisturizer with a higher oil content (like ointments and creams).
• Wear cotton gloves when doing dry chores around the house, and a combination of cotton gloves and vinyl gloves when doing work that gets your hands wet.
• Use disposable gloves for working with foods like potatoes, onions, peppers, meat, or acidic fruits.
• Remove rings while doing housework and before washing your hands.
• Once the eczema clears, your healthcare provider may suggest you use petroleum jelly on your hands, covered by gloves, overnight.
  

For keratolysis exfoliativa:

• Protect your skin from irritants.
• Use hand cream (particularly ones that contain urea, lactic acid, or silicone).

For jock itch:

• Wash the area and dry with a clean towel that is separate from the one you use for the rest of your body.
• Use an antifungal product as directed.
• Change clothing daily (especially underwear).
• Treat other fungal infections, such as athlete's foot, if applicable.
  

Chemical Peel

A chemical peel (chemoexfoliation) is a procedure used to improve the appearance of the skin on the face, neck or hands.

It may be used for:

• Pigmentary disorders: Lentigines, ephelides, melasma
• Inflammatory disorders: Acne, rosacea
• Scarring: Acne, traumatic, surgical
• Chronoaging: Superficial and medium-depth wrinkles
• Precancerous lesions: Actinic keratoses

With a chemical peel, different acidic solutions (salicylic acid, lactic acid, glycolic acid) are used on the skin to stimulate:

• Skin exfoliation
• Depigmentation
• Revitalization

Chemical peels work by loosening the "glue" that holds dead skin cells to the skin underneath, letting the dead skin slough off.

There are three levels of chemical peel: superficial, medium, and deep peels.

Superficial/lunchtime peel:

• It uses mild acid (such as alpha hydroxy acid).
• It penetrates the outer layer of skin only.
• It can improve the appearance of mild skin discoloration and rough skin, and to refresh the face, neck, chest, or hands.
• It requires one to seven days to heal.
• The treated skin will be red at first and may scale.
• Lotion or cream should be applied until the skin heals.
• Sunscreen should be used daily.
  

Medium peel:

• Trichloroacetic acid is used.
• It penetrates the outer and middle layers of skin.
• It removes damaged skin cells.
• It can improve age spots, fine lines/wrinkles, freckles, and moderate skin discoloration.
• It may be used to smooth rough skin and treat some precancerous skin growths.
  
• it requires one to two weeks to heal.
• Treated skin will be red and swollen at first, with swelling worsening for the first 48 hours (eyelids may swell shut)
• Blisters may form and break.
• Skin crusts and peels off in one to two weeks.
• Skin must be soaked for a specified period of time, then ointment applied.
• Based on an individual's medical history, antiviral medication is taken for 10 to 14 days. (Antivirals are always used in deep peels.)
• Sun exposure needs to be avoided until healing is complete.
• A follow-up appointment is necessary.
  

Deep peel:

• Trichloroacetic acid or phenol is used.
• It penetrates the middle layer of skin.
• It is used on the face.
  
• It can remove damaged skin cells, moderate lines, age spots, freckles, and shallow scars.
• It can dramatically improve in skin's appearance.
• It may be repeated with caution after one year.
  
• It requires two to three weeks to heal.
• The treated area will be bandaged.
• For the first two weeks, skin must be soaked four to six times daily, followed by a thick moisturizer
• Antiviral medication is taken for 10 to 14 days.
  
• Sun exposure must be avoided for three to six months.
• Several follow-up appointments are necessary.
  

Laser Resurfacing

Laser skin resurfacing is a cosmetic procedure that uses short, pulsating, concentrated beams of light to address skin issues such as wrinkles, blemishes, scars, sun-damaged skin, and warts.

The procedure removes the outer layer of skin, and heats the underlying skin, which stimulates the growth of new collagen fibers, resulting in smoother and firmer skin as the treated area heals. It is usually done as an outpatient procedure and generally takes between half an hour to two hours.

After the treatment, you may experience:

• Redness
• Swelling
• The feel of a mild sunburn
• Itching
• Stinging

Some people experience symptoms similar to a severe sunburn, with raw, possibly blistering skin that may ooze a yellow liquid and crust over. Scratching or picking these crusts could cause scarring.

Typically, about five days after treatment, the skin becomes dry and peels. The new skin underneath will gradually lighten, usually in two to three months, but possibly up to a year.

It's important to choose a board-certified facial plastic surgeon who is a member of the American Society of Plastic Surgeons (ASPS) and Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Follow their aftercare directions as directed.

Severe Skin Peeling: What’s Dangerous? 

Toxic epidermal necrolysis (TEN) is a severe, life-threatening skin disorder, which causes blistering and peeling of the skin. The skin peels in sheets, leaving large, raw areas exposed, and allowing fluid and salts to seep from the damaged areas. These areas are vulnerable to infection.

Symptoms can vary from person to person, but some other common symptoms may include:

• A painful, fast-spreading red area
• Peeling skin (may happen without blistering)
• Raw areas of skin
• Discomfort
• Fever
• May spread to eyes, mouth/throat, genitals/urethra/anus
  

Symptoms of TEN may resemble other skin conditions. Because of the severity of the condition, talk to a healthcare provider if you have symptoms that are consistent with TEN.

Toxic epidermal necrolysis can be caused by a drug reaction, most often to antibiotics or anticonvulsants. Your healthcare provider may suggest discontinuing this medication.

The condition progresses quickly, typically within three days, and usually requires hospitalization. Treatment may include:

• Hospitalization, often in the burn unit
• Isolation (to prevent infection)
• Ointments
• Protective bandages
• Intravenous (IV) fluid and electrolytes
• Antibiotics
• IV immunoglobulin G (type of antibody)

Medical Treatment for Skin Peeling 

Treatment for keratolysis exfoliativa may include:

• Acitretin (a retinoid)
• Photochemotherapy (Uses a photosensitizing compound and ultraviolet radiation)

Mild jock itch may be treated with over-the-counter (OTC) antifungal creams, sprays, or powders. Oral or topical prescription medication may be needed for more serious infections.

Hand eczema treatment may include medications such as:

• Antihistamines
• Biologics
• Topical corticosteroids

Summary

Peeling skin can occur for a number of reasons, including sunburn, peeling skin syndrome, hand eczema, jock itch, scarlet fever, and other medical conditions.

Care for peeling skin depends on the reason it is peeling, but typically involves treating the underlying cause, and keeping skin moisturized. Occasionally, medications may be needed. A chemical peel is a procedure that uses acidic solutions to improve the appearance of skin on the face, neck, chest, and/or hands.

Toxic epidermal necrolysis is a severe, life-threatening skin disorder, which causes the skin to blister and peel in sheets. It usually requires hospitalization.