What is Asteatotic Eczema (eczema craquelé)?
Asteatotic eczema, also referred to as cracked skin eczema or dry skin eczema, is a common type of skin rash that causes itching. This particular type of eczema is characterized by dry, scaly, and inflamed skin that often resembles a cracked pavement – hence the alternative name “crazing paving.” It tends to start with dry skin and, as the condition worsens, the skin may crack and create gaps. These gaps, or fissures, are caused by the skin losing its natural moisture.
People who have this skin condition often report itchiness related to their dry skin. It mostly occurs in the colder winter months when skin naturally tends to dry out. It’s also more frequently seen in older individuals. This type of eczema can show up anywhere on the body, but it’s usually found on the front and side areas of the lower legs. Sometimes, it can also appear on the back, trunk, and arms.
Studies have shown that it can sometimes be linked to other underlying health conditions such as cancer, an underactive thyroid (hypothyroidism), and poor nutrition. Certain types of medicines have also been connected to this form of dry skin eczema, including water pills (diuretics), vitamin A-related drugs (retinoids), and cancer treatments (antineoplastics agents).
What Causes Asteatotic Eczema (eczema craquelé)?
Skin dryness often happens due to water loss from the top layer of your skin. This is especially common in chilly, dry climates and during winter. Some medicines, such as diuretics (drugs that remove excess water in your body), can also make your skin drier.
Several other factors can lead to a condition called asteatotic eczema, which is when the skin becomes extremely dry, cracked, and itchy. These can include lesser oily and sweat gland activity, especially in older people; rough physical rubbing against skin; extended periods of hot bathing; and use of substances that remove grease from the skin.
Rarer causes of skin dryness and asteatotic eczema include exposure to radiation, not having enough of certain nutrients like zinc and essential fats, having an underactive thyroid (hypothyroidism), using certain drugs like diuretics and antiandrogen therapy (medicines to reduce male hormones), and presence of cancers.
Risk Factors and Frequency for Asteatotic Eczema (eczema craquelé)
Up to seventy percent of older adults have skin conditions, many of which involve dry, itchy skin. Asteatotic eczema, a type of dermatitis that causes severe itching, is particularly common. In fact, it’s one of the three most common types of dermatitis, second only to atopic dermatitis and widespread eczema. It is most often seen in the elderly.
- Asteatotic eczema mostly occurs during the winter months.
- In the United States, it’s more common in the northern regions.
- The increase in cases during winter is likely due to heating systems that lower indoor humidity and dry out the skin.
- The condition usually affects those over 60 years of age, with the average patient being 69.
- However, young people can also develop asteatotic eczema.
Signs and Symptoms of Asteatotic Eczema (eczema craquelé)
When a doctor is trying to diagnose dermatitis, the first thing they will look into is the timing of the flare-up. It’s important to know that dermatitis is more common in the winter. Patients usually complain about having dry, itchy skin, which is a main symptom of the condition. Other factors that the doctor might consider include the frequency of the patient’s showers or baths, the kind of soap they use, their diet, and any medications they are taking.
During the physical examination, the doctor will look for specific signs on the skin. Dermatitis typically causes the skin to be dry and flaky. The lines on the skin may become more pronounced, which is a classic sign of the condition. If the skin becomes drier and the patient has been scratching, red patches with thin, long, surface-level cracks may appear. The cracks and flaky patches might form a curvy, polygonal, or circular pattern. This pattern is formed when short vertical cracks connect with horizontal ones.
Scaly patches are often accompanied by secondary sores caused by rubbing or scratching. These sores can turn red and swell. Bleeding can occur when the tiny blood vessels in the skin are damaged as the disease progresses or due to continued scratching. Similar inflammation patterns might appear on the torso and upper arms as the winter moves forward.
Testing for Asteatotic Eczema (eczema craquelé)
The process of diagnosing asteatotic eczema typically relies on a doctor’s evaluation. However, if it’s hard to distinguish it from other skin issues, a skin biopsy could be a helpful tool. This type of test involves obtaining a small sample of skin to examine under a microscope. The biopsy results might show patterns typical of subacute eczema, such as skin thickening (acanthosis) or an influx of white blood cells, specifically lymphocytes, situated around blood vessels close to the skin’s surface.
Treatment Options for Asteatotic Eczema (eczema craquelé)
Maintaining skin hydration is the main treatment for asteatotic eczema. This is usually achieved by using moisturizing lotions with high oil content, as lotions with a lot of water can actually dry out the skin more. It’s best to apply these moisturizing creams, known as emollients, twice every day and straight after bathing, to help keep the skin hydrated.
Alongside these creams, topical steroids might be used. Mild conditions may be treated with low potency steroids such as desonide and hydrocortisone. For moderate cases, higher potency corticosteroids, like fluocinolone, triamcinolone, and betamethasone may be suggested. It’s important to keep using the moisturizing emollients while using these steroids, though it doesn’t matter which you apply first.
Other treatments have also been shown to be effective. For instance, a cream called pimecrolimus cream 1% helps control itching in people with asteatotic eczema. Moisturizers with alpha-hydroxyl acid can also be beneficial when applied after warm water baths or steroid ointment treatment.
There are other simple steps that can help prevent the skin from drying out too. These include bathing less often, minimizing soap usage, and using a humidifier in dry environments.
Finally, there are a couple of phospholipids, called N-palmitoylethanolamine (PEA) and N-acetylethanolamine (AEA), that belong to the endocannabinoid system and could be potential future treatments. A study has shown that emollients containing PEA and AEA improved skin function and reduced itching. However, more research is needed.
What else can Asteatotic Eczema (eczema craquelé) be?
When diagnosing a certain skin condition, doctors might consider several other conditions that could have similar symptoms. Some of these conditions might include:
- Sudden skin swelling or stretching syndrome
- Myxedema, which is severe hypothyroidism
- Cellulitis, a bacterial skin infection
- Stasis dermatitis, a skin irritation due to pooled blood
- Allergic contact dermatitis, a skin reaction to a specific allergen
- Irritant contact dermatitis, a skin reaction to an irritating substance
- Nummular dermatitis, which causes coin-shaped spots to develop on the skin
It’s important for the doctor to carefully consider these possibilities and conduct the necessary tests to arrive at an accurate diagnosis.
What to expect with Asteatotic Eczema (eczema craquelé)
Asteatotic eczema, a skin condition, generally responds positively to treatment. However, it can reappear during winter or if the original causes are not eliminated.
Possible Complications When Diagnosed with Asteatotic Eczema (eczema craquelé)
Asteatotic eczema can sometimes be very severe, with deep, wide cracks that may ooze a pus-like substance. For these severe cases, pain is often more of an issue than itching. If a person with this condition scratches their skin or uses drying lotions, it can lead to an infection and the buildup of crusty, pus-filled material on their skin.
Preventing Asteatotic Eczema (eczema craquelé)
If you have a condition known as asteatotic eczema, rest assured that it’s usually a harmless skin issue. However, it’s worth noting that, in some cases, this condition can be associated with certain types of cancer. One crucial aspect of managing asteatotic eczema is the use of moisturizing creams, also known as emollients. It’s vital for people with asteatotic eczema to be aware of the risks of scratching. Scratching can break the skin and may possibly lead to infections. Finally, you should understand that this skin condition often comes back during the winter months.
