Asteatotic Eczema: Signs, Causes and Treatments

Written by Medicover Team and Medically Reviewed by Dr Girishma J , Dermatologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Asteatotic eczema, also known as xerotic eczema or eczema craquele, is a prevalent dermatological condition, particularly among older adults. Characterised by dry, cracked, and itchy skin, this form of eczema often manifests during the colder months when humidity levels plummet, exacerbating the dryness of the skin. Understanding the causes, symptoms, and treatment options for asteatotic eczema is essential for effective management and relief from its discomforting symptoms.

What is Asteatotic Eczema?

Asteatotic eczema is a type of eczema that typically affects individuals with inherently dry skin. It is marked by the presence of fine cracks and fissures on the skin's surface, resembling the appearance of cracked porcelain. Unlike other forms of eczema, asteatotic eczema is not associated with oozing or blistering but primarily involves scaling, itching, and inflammation.

Asteatotic Eczema vs. Other Eczema Types

While eczema, in general, is a term used to describe a group of conditions that cause inflammation of the skin, asteatotic eczema differs from other types, such as atopic dermatitis or contact dermatitis. Asteatotic eczema is uniquely linked to extreme dryness and is predominantly seen in older adults, whereas other forms of eczema might be related to allergens or genetic predispositions.

What Are the Causes of Asteatotic Eczema?

The primary cause of asteatotic eczema is the depletion of lipids in the skin, which leads to a compromised skin barrier. This depletion results from various factors, including:

Age-Related Changes

As individuals age, the skin undergoes structural and functional changes. The production of natural oils decreases, leading to a reduction in moisture retention capabilities. This makes older adults particularly susceptible to asteatotic eczema, as their skin becomes drier and more prone to irritation.

Environmental Factors

Environmental conditions, especially low humidity and cold weather, play a significant role in the development of asteatotic eczema. The lack of moisture in the air during winter months can strip the skin of its natural oils, exacerbating dryness and leading to the characteristic cracking and itching.

Harsh Soaps and Detergents

Frequent use of harsh soaps, detergents, and cleaning agents can strip the skin of its natural oils, disrupting the skin's barrier function. This can trigger or worsen asteatotic eczema, making it crucial to use gentle, moisturising cleansers.

Genetic Factors

While not as strongly linked to genetics as atopic dermatitis, a family history of eczema or other atopic conditions can increase the likelihood of developing asteatotic eczema.

What Are The Symptoms And Warning Signs Of Asteatotic Eczema?

The symptoms of asteatotic eczema mainly affect the skin's surface and can worsen if dryness is not managed. Early identification helps prevent severe skin damage.

These symptoms are usually persistent and may intensify with environmental triggers or improper skin care.

Dry, scaly skin: The skin appears dry and flaky, often with a noticeable pattern of fine cracks.
Itching: Persistent itching is a common symptom that can lead to scratching and further skin damage.>
Inflammation: The affected areas may become red and inflamed, especially if the condition is exacerbated by environmental factors or irritants.
Fissures: In severe cases, the skin may develop deep, painful cracks that can bleed.

When to See a Dermatologist for Asteatotic Eczema?

Asteatotic eczema can severely impact your quality of life, causing intense itching, painful cracking, and sleepless nights. If symptoms worsen or become infected, medical attention is necessary to prevent serious skin complications.

You should see a doctor if you have:

Persistent dryness, deep skin cracks, or bleeding that does not improve with regular moisturising treatment
Intense itching that disrupts your sleep or daily activities for more than two weeks
Widespread rash spreading beyond the legs to the trunk, arms, or other body areas

Get medical help immediately if:

Skin becomes red, swollen, warm, or starts oozing pus, indicating a possible bacterial infection
You develop fever, chills, or swollen lymph nodes alongside worsening skin symptoms
Painful, deep fissures cause significant bleeding that cannot be controlled at home

These could be signs of a serious complication like Asteatotic Eczema, which needs urgent care from a dermatologist.

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How Is Asteatotic Eczema Diagnosed?

Asteatotic eczema is diagnosed through a clinical evaluation of the skin and a review of the patient's medical history. Additional tests may be performed to rule out other skin conditions or identify contributing factors.

Medical history: Assessment of symptoms, skin care habits, environmental exposures, medications, and underlying medical conditions.
Physical examination: Evaluation of dry, cracked, itchy, and inflamed skin with the characteristic "crazy paving" appearance.
Skin examination: Identification of the distribution and severity of eczema lesions.
Patch testing: May be recommended if allergic contact dermatitis is suspected.
Skin biopsy: Rarely required but may be performed to rule out other inflammatory skin disorders when the diagnosis is uncertain.
Blood tests: Occasionally ordered to identify underlying conditions such as nutritional deficiencies, thyroid disorders, or diabetes that may contribute to dry skin.

What Are The Treatment Options for Asteatotic Eczema?

Effective management of asteatotic eczema focuses on addressing the underlying dryness and restoring the skin's barrier function. Treatment options include:

Moisturization

Regular and intensive moisturization is the cornerstone of asteatotic eczema management. Emollients and moisturisers should be applied frequently, especially after bathing, to lock in moisture. Products containing ingredients like ceramides, glycerin, and hyaluronic acid are particularly beneficial in restoring the skin's lipid barrier.

Topical Steroids

For more severe cases, topical corticosteroids may be prescribed to reduce inflammation and itching. These should be used under the guidance of a healthcare professional to prevent potential side effects.

Humidifiers

Using a humidifier in living and sleeping areas can help maintain a more consistent moisture level in the air, reducing the drying effects of indoor heating during winter months.

Gentle Cleansing

Avoiding hot showers and using mild, fragrance-free cleansers can prevent further irritation and dryness. It's important to pat the skin dry and apply moisturiser immediately after cleansing.

Dietary Considerations

A diet rich in omega-3 fatty acids, antioxidants, and vitamins can support skin health and may help in managing eczema symptoms. Staying hydrated by drinking adequate water is also essential.

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Managing Asteatotic Eczema in Older Adults

Older adults need to pay particular attention to skin care routines to prevent the onset or worsening of asteatotic eczema. Regular skin assessments, gentle cleansing, and the use of emollients are vital in maintaining skin health. Additionally, routine check-ups with dermatologists can help in adjusting treatments as needed.

Preventive Measures

Preventive strategies for asteatotic eczema include wearing protective clothing during cold weather, avoiding known irritants, and maintaining a consistent skin care regimen. Regularly monitoring skin changes and seeking medical advice early can prevent complications.