Peeling skin is fortuitous damage to and loss of the upper layer of your skin (epidermis). Peeling skin can develop as a result of direct skin damage, such as sunburn or infection. It could also be an indication of an immune system problem or another illness. Peeling skin can cause rashes, irritation, dryness, and other irritating skin problems. Peeling skin can be caused by a variety of disorders, some of which are very serious. It's critical to receive a proper diagnosis as soon as possible.
Your skin is constantly exposed to external factors that might irritate and harm it. Sun, wind, heat, dryness, and high humidity are all examples. Skin peeling can occur as a result of repeated irritation. It's very uncommon for newborns born over their due date to endure some painless skin peeling. Skin peeling can also be caused by an illness or condition that begins somewhere other than your skin.
Conditions that may cause general skin peeling include:
Specific diseases and conditions that can cause peeling skin include:
Peeling skin syndrome (PSS) is a group of rare inherited skin disorders in which the normal gradual process of invisible shedding of the outermost skin layers is hastened and/or aggravated. PSS is characterized by painless, continual, spontaneous skin peeling (exfoliation) due to a separation of the outermost layer of the epidermis from the underlying layers. Other findings may include blistering and/or reddening of the skin and itching. Symptoms may be present from birth or appear in early childhood and are often exacerbated by friction, heat or other external factors. Based on the extent of skin involvement, PSS may involve the skin of the entire body (generalized form) or is limited to the extremities, mostly hands and feet (localized form). Generalized PSS can be distinguished into an inflammatory type which is more severe, and a milder, non-inflammatory type. PSS may be caused by disease-causing variants in multiple genes encoding proteins with crucial functions for cell-cell adhesion.
Most forms of PSS manifest at birth or during infancy with shedding or peeling of the outermost layer of the skin. Skin peeling is spontaneous, painless, and may persist lifelong with gradual improvements. Often, affected individuals and their caregivers can remove sheets of skin manually, comparable to skin peeling after a severe sunburn. Other findings associated with this disorder may include blistering and skin fragility, itching, short stature, and/or newly formed hairs that can be plucked out more easily than normal. Skin peeling is often exacerbated by mechanical irritation of the skin, heat, sweat or water exposure or other external factors.
In the localized types, individuals develop blisters and erosions on hands and feet at birth or during infancy. The generalized inflammatory types may be associated with generalized inflammation of the skin (erythroderma) or localized thickened, red plaques (erythrokeratoderma), immuno-dysfunction, allergies, and susceptibility to infections, failure to thrive or metabolic wasting. In some patients, these disorders may be life-threatening, especially during the newborn period. Due to the variable clinical presentations of PSS, its often mild features and gradual improvement with age, PSS may be underdiagnosed and underreported.
To date, genetic changes in several distinct genes have been reported to cause PSS. All known forms of peeling skin syndrome are inherited in an autosomal recessive pattern. Recessive genetic disorders occur when an individual inherits two abnormal copies of the disease gene, usually one from each parent. If an individual receives one normal gene copy and one abnormal gene copy for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the altered gene copy and, therefore, have an affected child is 25% with each pregnancy.
The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents is 25%. The risk is the same for males and females. All individuals are thought to be carriers for at least 4-5 abnormal recessive genes. Parents who are close relatives have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.
A good history and physical exam are often sufficient to make the diagnosis, although specialized tests including surgical removal and microscopic evaluation (biopsy) of affected tissue may be necessary at times.
Treating peeling skin syndrome by applying skin softening ointments, especially after a bath while the skin is moist, may offer some relief. Plain petroleum jelly or Vaseline is preferred.
To discuss the risk of having children with this disorder and the possibility of genetic testing, genetic counselling is recommended for affected individuals and their families.
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. Rare Disease Database. (2021) Retrieved from https://rarediseases.org/rare-diseases/peeling-skin-syndrome/
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