Introduction:
Peeling skin is the shedding or loss of the outer layer of skin. It is a sign that the skin is healing from some type of damage, which can be caused by a variety of mild to serious conditions such as sunburns, allergies, or skin diseases. In rare cases, it can also be a sign of a serious underlying condition. Depending on the cause of peeling, treatment can range from over-the-counter drugs to professional treatment for the underlying disease which causes the condition. The peeling of the skin is medically called desquamation; it is the shedding or loss of the outer layer of skin, which is called the epidermis.
What Is Skin Peeling?
There are different layers in the skin, the most mature being on the top layer. As it matures or if any damage occurs, the top layer is shed, and new cells from the bottom layer take its place. Desquamation or peeling of the skin happens when the body sheds the outermost layer of the skin. Flaking or peeling is the process of recovery from damage caused by various factors. Environment, sun, allergies, skin conditions, or even medical treatment can be the source of damage to the skin.
What Causes Skin to Peel?
Replacement of the outermost layer of skin causes skin shedding. Peeling skin may be scaly or dry, irritated, or itchy. There are different causes for the skin to peel, such as:
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Skin Damage:
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Sunburn.
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Friction or irritation.
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Burns.
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Genetic or Inflammatory Diseases:
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Peeling skin syndrome.
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Kawasaki disease.
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Skin Conditions:
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Infectious Diseases:
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Toxic shock syndrome.
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Impetigo.
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Streptococcal infections like scarlet fever
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I Skin Damage:-
1. Sunburn: Any part of the body can be affected by exposure to the sun. Sunburn, as it heals, can cause the skin to peel. This is a response to the old layer being shed off as the new layer is being formed.
Treatment: It is best to prevent sunburns by using sunscreen, but if it occurs, it can be treated by drinking water and applying moisturizer. Sunburn can be treated by taking frequent and cool baths. The application of mild cortisone can also help calm the skin.
2. Hand-washing: Although hand-washing is part of hygiene, excessive use of soap can cause skin peeling.
Causes: Some harsh soaps can strip the natural barrier leading to skin peeling. Peeling can also occur as a result of an allergic reaction to an ingredient in the soap. Excessive use of hand sanitizer can also cause the skin to dry out due to the alcohol content in the sanitizer.
Treatment: Even though hand-washing can disinfect the skin, it removes the natural oils, and therefore it is best to wash the hands in lukewarm water with a mild soap, followed by drying the hands in a clean towel and using a moisturizing cream while the hands are still damp. Ensure that the cream covers all the areas.
3. Temperature Changes: Climate change can also affect the skin. During winter, the atmospheric humidity is low, causing the skin to lose moisture (transepidermal water loss), leading to skin peeling and cracking.
Treatment: In winter conditions, it is important to prevent water loss through the skin, in addition to moisturizing the skin. Therefore applying moisturizer to damp skin after showering, followed by using humectants such as petroleum jelly, can provide relief.
II Genetic or Inflammatory Diseases:-
1. Acral Skin Peeling: Acral peeling skin syndrome is a disorder that presents as a painless peeling of the top layer of skin. It is most apparent on the top layers of feet and hands, hence the term acral. This condition is evident at birth but can also develop later in life or during childhood. Exposure to heat, humidity, friction, or moisture can make the skin peel worse. It is also called A.P.S.S or peeling skin syndrome. It is not associated with any other health conditions, and although the skin may be itchy and red, it usually heals without scarring.
Symptoms: It is a rare skin condition, and the signs and symptoms are usually mild and similar to other conditions. Therefore there is a chance for the skin condition to be misdiagnosed. The skin peeling is most noticeable in areas that are exposed to moisture and friction.
Cause: It is caused by the mutation of a gene called TGM5, which is responsible for making the enzyme transglutaminase 5. This transglutaminase is a component of the outer layer of skin called the cornified cell envelope. This cornified layer acts as a barrier surrounding the epidermal cells. When a mutation occurs in the gene, subsequently transglutaminase production is also affected. This shortage weakens the cornified layer, and epidermal cells are easily separated, leading to skin peeling.
2. Inheritance: This condition is an autosomal recessive disorder. Hence only if both copies of a gene are affected the disease is expressed. If only one copy is affected, then the signs and symptoms are not expressed.
Treatment: Treating the disorder helps heal the skin condition. Immune globulin can be given intravenously, along with Aspirin.
3. Kawasaki’s Disease:
Kawasaki’s disease is caused by the inflammation of blood vessels. It is seen in young children. Skin peeling is seen as a secondary symptom of this disease.
III Skin Conditions:-
1. Dermatitis:
Atopic dermatitis, irritant dermatitis, and hand dermatitis are conditions that occur when the skin barrier is affected. Hand dermatitis can be caused as a result of allergic reactions. It can present as dry, itchy skin, which is inflamed, and rough patches are seen on the skin. Atopic dermatitis presents as skin-colored blisters. Irritant contact dermatitis occurs due to inflammation when exposed to an allergen or chemicals. Poison ivy, rubber gloves, and nickel are some of the allergens that can trigger an immune response.
Treatment: These can be treated by reducing exposure to allergens, avoiding soaps that are harsh, and using moisturizers after hand-washing.
2. Psoriasis:
Psoriasis is an autoimmune disorder that occurs due to cell growth cycle impairment. It presents as scaly skin that flakes off along with pain and itchiness.
3. Seborrheic Dermatitis:
It is a form of eczema that occurs in areas such as the nose, scalp, and upper back. The skin becomes scaly and discolored, with flakes peeling off. Yellow-brown scales can be seen.
Treatment: Antifungals can be used in combination with corticosteroids if the condition is severe.
4. Athlete’s Foot:
It is an infectious skin condition due to fungi; it can spread due to skin-to-skin contact by sharing damp areas such as locker rooms, showers, and swimming pools. The skin becomes itchy and flakes off.
Treatment: Antifungals are effective in treating the condition. It is also advisable to not share socks and use footwear in common showers, locker rooms, and swimming pools.
IV Infectious Diseases:-
1. Impetigo:
A bacterial infection that is characterized by blisters and rashes is commonly seen in children of the age group two to six. If a bite or scratch gets exposed to bacteria, it can give rise to impetigo. Blisters can break, leading to rashes and patches on the skin.
Treatment: Topical and oral antibiotics are used to treat the underlying staphylococcus infection.
2. Toxic Shock Syndrome:
TSS is an emergency and fatal condition that arises due to staphylococcus aureus infection. It can be caused by nasal packing or a tampon that was infected. It presents as fever, decrease in blood pressure, and sunburn-like rash and can lead to end-organ failure.
Treatment: It is treated as an emergency condition; the patient is given intravenous antibiotics and fluids to manage the infection and dip in blood pressure. Managing the systemic condition will help elevate the skin condition.
3. Scarlet Fever:
It is caused by a Streptococcus infection, which gives rise to fever, rash, and throat pain. The rash is red, which blanches on pressure.
Treatment: Antibiotics are used to treat the infection; Penicillin or Amoxicillin is the drug of choice for this condition.
How to Diagnose the Cause?
Skin peeling can occur due to several different reasons, and because of this, it is important to identify the cause to treat the disorder. Diagnosis is based on detailed medical history, analysis of clinical symptoms, and family history. The dosages of medications, supplements, and vitamins are necessary to arrive at a diagnosis.
Additionally, tests can be performed to confirm or rule out other conditions that are likely to cause peeling skin, such as blood tests, allergy tests, and skin biopsies.
How to Treat Peeling Skin?
Since peeling skin is not a condition but rather an aftereffect of other skin conditions or damage, the treatment is based on the cause. Therefore the treatment consists of
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Allergic medications.
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Corticosteroids.
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Antibiotics.
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Antifungals.
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Nonsteroidal anti-inflammatory drugs (NSAIDs).
Conclusion:
The shedding off of the outermost layer of the skin is called skin peeling or desquamation. It can be caused due to many factors, such as underlying skin conditions, sun damage, friction, allergic reactions, or even infections. Since there are different etiologies, it is difficult to diagnose the condition. Once the condition has been identified, treating the cause will give relief to the skin peeling. In most cases, other than infectious conditions, proper cleanliness and the use of moisturizer and humectants can help manage the condition.
