Asteatotic eczema

Synonym(s)

Asteatotic dermatitis; eczema craquelé; eczema craquelatum; xerotic eczema; eczema hiemalis; eczema fendille; etat craquelé

Definition

Pruritic, cracked, and fissured skin occurring most commonly on the shins of elderly patients, caused by lack of moisture in the skin

Pathogenesis

Physiologic process with aging; seen more often in the winter, with cold air outside and heated air inside causing a decrease in humidity; loss of water by stratum cor-neum causing cells to shrink and creating fine fissures; eczematous changes resulting from patients rubbing and scratching these pruritic areas

Clinical manifestation

Minimally scaly, red, cracked, and or fissured skin, giving the appearance of a "cracked pot"; most commonly involving

68 Ataxia-telangiectasia the pretibial areas, but also the thighs, hands and trunk; generalized pruritus, often worse after bathing

Differential diagnosis

Ichthyosis; atopic dermatitis; nummular eczema; stasis dermatitis; contact dermatitis; mycosis fungoides; other causes of generalized pruritus: scabies; atopic dermatitis; drug reaction; obstructive hepatobil-iary disease; end-stage renal disease; polycythemia vera; Hodgkin's disease; thyroid disease; hyperparathyroidism; psycho-genic pruritus

Therapy

Decreased bathing; use of soap substitutes such as bath gels; application of emollients at least twice daily during the winter months; mid potency topical corticosteroid ointment; antihistamines, first generation, for nighttime sedation

References

Beacham BE (1993) Common dermatoses in the elderly. American Family Physician 47(6^1445-

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