Skin peeling on the hands and feet: causes and when to see a GP

The outer layer of the skin is constantly renewed, and peeling happens when that layer is shed in visible sheets or flakes rather than invisibly. Hands and feet are particularly exposed to water, soaps, friction, heat, sweat and enclosed footwear, so they show the effects of irritation or inflammation first.

The most helpful clue to the cause is what came before the peeling: blisters, itch, a burn, an illness with a rash, or simply dryness. The sections below set out the causes described by the NHS.

The table summarises the main causes and the features that distinguish them. The NHS stresses that other conditions can cause sore, itchy patches or blisters on the hands and feet and that you should not try to diagnose yourself if you are worried.

The NHS describes pompholyx as usually a long-term condition that comes and goes. The first symptom is often itchy skin with a burning or prickling feeling, followed by fluid-filled blisters that are very itchy and may leak fluid. As they heal the skin may be dry, cracked and sore, and sometimes bleeds. It most often affects the fingers and palms but can affect the toes and soles.

Treatment includes daily emollients to stop the skin becoming dry and topical steroid creams used for a few weeks at a time. A GP may suggest soaking leaking blisters in potassium permanganate solution, prescribe antibiotics if infection develops, and refer to a dermatologist when symptoms are severe or treatment is not helping, in which case steroid tablets, ultraviolet light or alitretinoin may be considered. Practical measures include washing hands with warm water and a soap substitute, wearing cotton-lined gloves for chemicals and wearing cotton or silk socks.

The NHS says one of the main symptoms of athlete’s foot is itchy white patches between the toes, and it can also cause sore and flaky patches on the feet or fluid-filled blisters on the soles and sides. The skin may crack or bleed. If untreated, the infection can spread to the toenails and cause a fungal nail infection.

A pharmacist can recommend an antifungal cream, spray or powder, which usually takes a few weeks to work. The NHS advises drying between the toes, using a separate towel for the feet, wearing clean cotton socks each day, not sharing towels or shoes and wearing flip-flops in changing rooms. See a GP if pharmacy treatment does not work, if the foot is hot, painful and red, if the infection spreads to the hands, or if you have diabetes or a weakened immune system, because foot problems can be more serious in those situations.

The NHS says contact dermatitis is most commonly caused by irritants such as soaps and detergents, solvents or regular contact with water, and less commonly by allergens such as ingredients in cosmetics or metals such as nickel. It usually appears within hours or days of exposure and most often affects the hands. If the trigger can be identified and avoided, the skin will clear; emollients and, for severe symptoms, topical steroids can help. A GP may refer to a dermatologist if the cause cannot be found or treatment does not work.

Sunburn can also lead to peeling. The NHS advises not to scratch or try to remove peeling skin, not to pop blisters, and to seek urgent advice if the skin is blistered or swollen, or you feel very tired, dizzy, sick or have a high temperature.

Peeling of the skin of the hands and feet sometimes follows an infection or an inflammatory illness. The NHS notes that in scarlet fever the skin sometimes peels like sunburn as the rash fades, and scarlet fever needs antibiotics from a GP. In children, the NHS describes Kawasaki disease, a rare condition with a high temperature lasting 5 days or more, a rash, bright red palms and soles, red eyes and cracked lips, for which it advises an urgent GP appointment or NHS 111. A child who is unwell with fever and a rash should be assessed promptly.

If peeling occurs repeatedly without an obvious trigger, if it is painful, or if you also have fever, joint pain, mouth sores or a new rash elsewhere, see a GP. Some medicines can also cause skin reactions, so tell your doctor about any new tablets.

See a pharmacist for mild athlete’s foot, dry skin and sunburn. See a GP if the skin is very painful, weeping or crusted with a yellow-brown crust, if you have blisters that are leaking yellow or green pus (signs of infection), if the peeling keeps coming back, or if you have any skin change you are worried about. Use NHS 111 or urgent care for a hot, red, painful foot or leg, a fever, or if a child is unwell with a rash.

In the NHS, most causes are managed by a GP or pharmacist; a dermatologist is involved for severe or resistant cases. Private dermatology consultations offer quicker access, but the principles of treatment are the same.