Asteatotic eczema, also called eczema craquelé, is a common type of pruritic dermatitis that typically occurs on the lower extremities of older individuals with dry skin. Its incidence peaks during cold winter months. Water loss from the stratum corneum due to age-related skin barrier impairment is believed to be a key pathogenetic factor. Low environmental humidity (eg, cold and dry weather, central heating) and exposure to harsh detergents or irritants are well-known exacerbating factors.
In the vast majority of cases, asteatotic eczema is an isolated finding. Rarely, it may occur in association with an underlying condition, such as malnutrition, hypothyroidism, and malignancy, or as an adverse effect of certain drugs (eg, retinoids, diuretics, antineoplastic agents).
Clinical features and diagnosis — Asteatotic eczema typically presents with scaling and superficial fissuring of the skin resulting in the so-called "dried river bed" appearance, with varying degrees of inflammation. In severe cases, the fissures can be hemorrhagic. Pruritus is usually present.
The upper and lower extremities are the sites most commonly involved. Generalized forms have been rarely described in patients with cancer.
The diagnosis of asteatotic eczema is usually clinical. If performed, a skin biopsy usually shows a subacute, eczematous pattern with acanthosis, hyperkeratosis, mild spongiosis, and a superficial, perivascular, lymphocytic infiltrate.
Treatment — Asteatotic eczema usually responds promptly to treatment with topical corticosteroids. Emollients should be used liberally multiple times per day to avoid recurrence.