Asteatotic Eczema - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Asteatotic eczema is a common type of pruritic dermatitis. Asteatotic eczema can also be known as xerosis, dry skin. Asteatotic eczema is also termed eczema craquele. Asteatotic eczema is a dermatological condition characterized as dry, cracked, and fissured skin due to water loss in the epidermis. Asteatotic eczema is a common condition primarily observed in adults. Early diagnosis can avoid secondary lesions and infections. Asteatotic eczema can be observed in both dry and cold conditions.

What Is Asteatotic Eczema?

Asteatotic eczema or craquele is a skin disorder characterized by dry, cracked, and fissured inflamed skin. The skin at the beginning of this disorder is dry, and in severe cases, the skin will be cracked and cause fissures. Water loss in the epidermal layer causes fissures. The fissured skin is referred to as “crazing paving.” Crazing paving denotes the irregular fissures and the scaling pattern of dry skin. Asteatotic eczema is more prevalent in the winter months. Asteatotic eczema is also found to be in association with underlying systemic conditions.

What Is the Cause of Asteatotic Eczema?

Asteatotic eczema is a type of pruritic dermatitis that causes dry skin. Skin dryness is due to epidermal water loss. Epidermal water loss can occur due to a variety of reasons. Free fatty acids are decreased in people with asteatotic eczema, causing increased transepidermal water loss. A reduced amount of water in the stratum corneum layer causes asteatotic eczema.

Some contributing factors of asteatotic eczema are mentioned below:

• Low humidity conditions include winter, desert, high altitude, and travel.

• Medications such as diuretics.

• Decreased activity of sebaceous and sweat glands.

• Friction in the skin.

• Use of a dehumidifier or heater.

• Prolonged and frequent hot water bath.

• Use of degreasing agents.

• Radiation effect.

• Nutritional deficiency includes zinc and essential fatty acids.

• Hypothyroidism.

• Antiandrogen therapy.

• Malignant disorders.

What Are the Clinical Features of Asteatotic Eczema?

The clinical feature of asteatotic eczema is dry skin presenting with cracks and fissures. Asteatotic eczema primarily affects older people due to the decreased activity of sebaceous and sweat glands. Asteatotic eczema is usually seen on any skin area and is mainly seen in the anterolateral region of the lower legs. Asteatotic eczema is also seen in the back part, trunk, and arms. A characteristic feature of asteatotic eczema is a crazing paving appearance which refers to the irregular pattern of fissures.

The clinical features of the severe form of asteatotic eczema are pointed out below:

• Crazing paving appearance.

• Generalized erythema, causing redness.

• Localized swelling.

• Surface blistering.

• Pruritus.

• Primarily seen in older people over 60 years of age.

• Also, it occurs in young people.

• Found to be associated with underlying systemic disorders.

Who Is at Risk of Asteatotic Eczema?

Asteatotic eczema has no gender predilection and can occur in young people. The incidence rate of asteatotic eczema is higher in older people and follows atopic dermatitis.

The population at risk of developing asteatotic eczema is given below:

• Older people.

• Individuals with ichthyosis.

• People with malnutrition.

• Severe weight loss.

• Lymphoma patients.

• Specific drug intake such as Acitretin and Isotretinoin.

• People with diuretics and protein kinase inhibitors intake.

What Are the Complications of Asteatotic Eczema?

Asteatotic eczema in severe form has complications. The complications are due to irregular fissures. Excessive water loss may lead to deep fissures. The deep fissures affect the blood capillaries of the skin, causing bleeding and further complications.

The following points are some of the difficulties of asteatotic eczema:

• Bleeding in dermal capillaries.

• Pruritus leads to scratching.

• Excoriation of skin.

• Edematous patches.

• Lichen planus.

• Infection may occur due to allergens and bacterial penetration.

• Irritant contact dermatitis.

What Is the Diagnosis of Asteatotic Eczema?

The patient history and physical examination play a vital role in diagnosing asteatotic eczema. Therefore, the patient history should be included with the period of occurrence. Hallmark symptoms of asteatotic eczema are pruritus and dry skin. The physical examination in asteatotic eczema includes dry skin and fissures. Skin biopsy is usually not needed in diagnosing asteatotic eczema.

The various diagnostic measures for diagnosing asteatotic eczema as noted below:

• Proper history, which also includes the frequency of bathing, and soap used for bathing.

• The Diet history and drug intake of the patient are evaluated.

• Physical examination involves the appearance of red plagues and fissures in a curvilinear or polygonal pattern.

• Erythematous and edematous patches in the scratched areas.

• Bleeding in disease progression.

• Similar changes in trunk and upper extremities in winter.

• Histopathological findings include spongiotic dermatitis in intracellular edema, acanthosis, hyperkeratosis, and lymphocytic infiltration.

• Compact and irregular stratum corneal layer of the epidermis.

What Is the Differential Diagnosis of Asteatotic Eczema?

Possible symptoms of asteatotic eczema are observed in other conditions mentioned below. The comparison of symptoms with the following disorders helps to avoid the misdiagnosis of asteatotic eczema.

Some of the differential diagnosis of asteatotic eczema is as follows:

• Acute edema or cutaneous dissension syndrome.

• Myxedema is a thyroid deficiency disorder.

• Cellulitis.

• Allergic contact dermatitis.

• Stasis dermatitis.

• Irritant contact dermatitis.

• Nummular dermatitis.

What Is the Treatment for Asteatotic Eczema?

The primary treatment for asteatotic eczema is hydration of the skin with oil-based skin lotions. Topical steroids are used along with emollients. Corticosteroids can also be used with emollients in severe forms of asteatotic eczema.

The various agents used for the treatment of asteatotic eczema are described below:

• Use lotion with high oil content.

• Application of emollients after bath.

• Corticosteroid therapy includes triamcinolone, fluocinolone, and betamethasone.

• Pimecrolimus cream 1% to control pruritus.

• Application of topical alpha-hydroxy acid moisturizers.

• Steroid ointment.

• Patient education.

How to Avoid Asteatotic Eczema?

Aesthetic eczema can be avoided by keeping the skin hydrated. A proper diet is essential and plays a vital role in skin hydration. Certain foods provide beneficial effects on the skin by maintaining hydration and thereby avoiding skin dryness.

The tips to prevent asteatotic eczema are listed below:

• Intake of avocado.

• Hydrated foods and vegetable intake.

• Use cool water or lukewarm water for face wash and shower.

• Use a humidifier.

• Use moisturizer.

• Using the proper skincare routine for the season.

• Exfoliate regularly.

• Use sunscreen.

• Aloe vera-containing skin products add moisture to the skin.

• Use face masks.

• Stay hydrated by drinking plenty of water.

• Avoid smoking.

• Get enough sleep.

Conclusion

Asteatotic eczema, also known as eczema craquele, is a dry skin condition due to epidermal water loss. Asteatotic eczema is mainly observed in older people and is expected in the winter months. Patient education on the risk and complications of asteatotic eczema can be done. Usually, asteatotic eczema responds well to therapy. Therefore, patient education and doctor-advised treatment will improve the quality of patient life.