Normal Peeling of the Skin

Human skin has two main layers – an outer epidermis and inner dermis. The epidermis is made up of several layers of cells with the innermost known as the stratum basale and the outermost being the stratum corneum. The skin cells in the stratum basale gradually transform from living cells producing keratin (keratinocytes) to dead cornified cells (corneocytes) in the stratum corneum. These corneocytes provide the physical barrier that protects the internal environment of the body from the exterior.

The outermost layers of the skin are constantly shedding cells – a process known as desquamation. Humans shed outer skin cells throughout life and this is not usually noticeable in most cases as the new cells are constantly replacing the cells that are being shed. This is kept in balance to ensure that the outer stratum corneum is neither depleted during daily desquamation and nor does it become thicker than normal with a build up of cells.

What is Peeling Skin?

Peeling skin is the common term used to describe a large number of stratum corneum cells being shed together that is visibly apparent. The skin peels off as visible scales or layers of skin. It may occur on small areas of the skin or can affect the skin over most of the body simultaneously. In some diseases the stratum corneum thickens before is begins to peel while in other cases there is an excessive loss of cells simultaneously from an otherwise normal thickness stratum corneum. Peeling skin is not always a sign of any underlying disease – sometimes it can occur with acute injury caused by exposure to harsh weather, sunburn and chemicals. However, there are several systemic diseases that can cause persistent peeling of the skin along with pathology at other sites in the body. In these instances, treating peeling skin extends well beyond good skin care. It needs proper medical treatment.

Causes of Peeling Skin

The various causes of peeling skin can be due to :

  • Environment
  • Nutrition
  • Medication
  • Infections
  • Immune disorders

Atopic dermatitis (above) and
athlete’s foot (below)

Seborrheic dermatitis (below)

Pictures sourced from Dermatology Atlas.
Courtesy of Samuel Freire da Silva, M.D.

Environment

  • Sunburn is one of the most common acute causes of peeling skin caused by ultraviolet light. It appears after a few hours of direct sun exposure or from sunlight reflected off snow, sand and water.
  • Radiation exposure to the skin, also known as cutaneous radiation syndrome (CRS), causes damaged to the outer and even inner layers of the skin. It can arise after just a few hours of irradiation.
  • Frostbite is when the skin and underlying tissue freezes thereby damaging it. Frostnip is an early stage of frostbite where the skin is irritated but not damaged.

Nutrition

  • Vitamin deficiencies can affect overall health to varying degrees and the health of the skin may also be compromised depending on the type of vitamin that is deficient.

Medication

  • Chemotherapy is the use of certain drugs to treat cancers. It is associated with a host of side effects, one of which may be peeling skin.
  • Vitamin A excess, known as hypervitaminosis A, mainly occurs with over supplementation. It has a wide range of effects on many parts of the body including the skin.

Infections

  • Ringworm (dermatophyte) is a superficial fungal infection that can occur on various parts of the body including the feet (tinea pedis or athlete’s foot), groin (tinea cruris or jock itch), scalp (tinea capitis), body (tinea corporis), face (tinea faciei)  or hand (tinea manuum).
  • Staph skin infections are caused by a group of bacteria known as staphylococci. This type of bacteria is present on living and inanimate objects and is easily transmitted from person to person.
  • Measles (rubeola) is a viral infection commonly seen in childhood. Vaccinations have played a large part in the decreasing incidence of this otherwise common childhood infection mainly in developed countries.
  • Scarlet fever is a disease that occurs in children with strep throat as the strep bacteria releases toxins into the bloodstream. It is marked by a bright red rash on the skin and a strawberry red tongue along with fever and throat symptoms.
  • Toxic shock syndrome is caused by toxins from staphylococci and streptococci bacteria that is released into the bloodstream. It is mainly Staphylococcus aureus that is responsible and tampon use is one of the main causes of this syndrome.

Immune disorders

The following disorders may lead to peeling skin mainly through allergies or autoimmune reactions. In allergies, the immune system is abnormally sensitive and triggered by otherwise harmless substances. In autoimmune diseases, the immune system incorrectly attacks the body tissues like the skin.

  • Atopic dermatitis, also known as eczema, is an itchy chronic skin disease that is often first seen in young children. It is associated with an allergic disposition (atopy) and is often accompanied by asthma and hay fever.
  • Psoriasis is an autoimmune disorder where the skin thickens due to a excessive growth and slow desquamation leading to the plaques of dry and silvery white scaling skin.
  • Exfoliative dermatitis, or erythroderma, is a disease marked by skin redness and peeling scales which can be due to the use of certain drugs, other underlying diseases of the skin or other system, or it may occur for unknown reasons.
  • Seborrheic dermatitis is an inflammatory skin condition mainly affecting the areas with highest sebum (oil) concentration. It is linked to species of fungus normally found on the skin (Malassezia) but is not an infection. Rather it is an abnormal immune response to this fungus.
  • Cutaneous T-cell lymphoma is a rare form of skin cancer associated with malignancy of the lymphatic system (lymphoma).

Article reviewed by Dr. Greg. Last updated on March 24, 2012