Asteatotic eczema
📖 About
- Very common in the elderly, especially those in nursing or residential homes 🏡.
- Represents loss of normal skin barrier function, often recurrent and chronic.
🧬 Aetiology
- 🌬️ Environmental factors: dry air, central heating, low humidity (winter, deserts, high altitude, travel, dehumidifiers, fan heaters).
- 🧼 Excessive washing with soaps and detergents that strip lipids from the stratum corneum.
- 👵 Ageing skin → reduced sebaceous and sweat gland activity, thinner epidermis.
- Comorbidities such as hypothyroidism, malnutrition, or chronic renal disease may worsen xerosis.
🩺 Clinical Features
- Dry, cracked, and flaky skin – especially over shins, arms, and trunk.
- “Craquelé skin” – resembles cracked porcelain or dried riverbeds.
- May progress to xerotic eczema with erythema, pruritus, and excoriations.
- Secondary complications: cellulitis 🦠 due to skin barrier breakdown.
🔍 Differentials
- Atopic dermatitis (eczema).
- Contact dermatitis (allergic/irritant).
- Psoriasis (plaques with silvery scale).
- Ichthyosis vulgaris (hereditary, lifelong scaling).
- Hypothyroidism-associated dry skin.
🧪 Investigations
- Usually a clinical diagnosis.
- Consider TFTs if features suggest hypothyroidism 🦋 (fatigue, weight gain, bradycardia).
- Assess for diabetes or renal disease if recurrent/severe.
💊 Management
- 🛁 Reduce bathing frequency; avoid hot baths/showers and harsh soaps.
- 🌡️ Increase humidity at home (humidifiers, avoiding overheated rooms).
- 💧 Regular application of emollients (e.g. E45, aqueous cream, urea-based creams for severe cases).
- Switch to soap substitutes or gentle cleansers.
- Topical corticosteroids only if eczematous changes are present.
- Monitor for recurrence and secondary infection (cellulitis).
📚 References
🧾 Clinical Case – Asteatotic Eczema
An 80-year-old man presents in winter with intensely itchy, dry, cracked skin on his shins.
On examination, there are erythematous, scaly plaques with a “crazy-paving” appearance over the lower legs.
He denies atopy but reports long hot baths and central heating use.
Diagnosis: Asteatotic eczema (eczema craquelé), common in the elderly due to reduced skin lipids and low humidity.
Management included frequent emollients, soap substitutes, short course of topical steroids, and lifestyle advice to avoid excessive bathing.
