Asteatotic Eczema Clinical Presentation

  • Author: Christina K Anderson, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

History

During the winter months, an elderly person classically presents with pruritic and dry skin with dermatitis on the pretibial areas. Sometimes, the dysesthesia may be described as a pinprick or biting sensation.

  • Asking the patient about pertinent controllable factors, such as the following, is important:
    • Frequency of bathing, showering, and cleansing, and which soaps and cleansers are in contact with the skin
    • Types of skin lubricants used, and method and frequency of application
    • Diet
    • Medications
    • Types of clothing worn (Wool may cause irritation.)
    • The source, the type, and the temperature of heat that may alter the humidity of the environment
  • If the eruption persists despite therapy, behavioral changes, and treatment compliance, allergic contact dermatitis and irritant contact dermatitis and internal malignancy may require investigation.
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Physical

  • Primary lesions: Slightly scaly, inflamed, curvilinearly cracked and/or fissured skin most commonly involves the pretibial areas, but it may also occur on the thighs, on the hands, and on the trunk (see image below). Asteatotic dermatitis on the lower extremity. Asteatotic dermatitis on the lower extremity.
  • Secondary lesions
    • Excoriated, erythematous, edematous patches may result from rubbing or scratching.
    • Bleeding fissures secondary to the disruption of dermal capillaries have been described in exaggerated eczema craquelé, which begins as superficial cracks in the epidermis.
  • Generalized lesions: Generalized or extensive asteatotic dermatitis presents with primary lesions and secondary excoriations (see images below). Asteatotic dermatitis on the lower extremity. Asteatotic dermatitis on the lower extremity. Asteatotic dermatitis on the lower extremity. Asteatotic dermatitis on the lower extremity.
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Causes

Multiple etiologic factors may coexist to cause asteatotic dermatitis, including the following:

  • Xerosis and friction
  • Frequent or prolonged bathing in hot water, use of soap on the involved site, and infrequent use of emollients for water retention in the stratum corneum
  • Degreasing agents
    • Solvents
    • Cleansers
  • Decreased sebaceous and sweat gland activity in elderly persons
  • Decreased keratin synthesis in elderly persons
  • Low environmental humidity and cold winds that increase the loss of water by convection
  • Radiation
  • Long-term malabsorption of essential fatty acids, including linoleic acid and linolenic acid
  • Nutritional deficiencies
    • Zinc deficiency[3]
    • Essential fatty acid deficiency, such as linoleic acid deficiency or linolenic acid deficiency
  • Atopy
  • Ichthyosis
  • Thyroid disease - Myxedema and other thyroid diseases with diminished sweat and sebaceous gland activity[4]
  • Neurologic disorders - Decreased sweating in denervated areas
  • Drugs - Antiandrogen therapy[5] and diuretic therapy
  • Malignancies - Malignant lymphoma,[6] gastric adenocarcinoma,[7] glucagonoma, angioimmunoblastic lymphadenopathy,[8] breast cancer, large-cell lung carcinoma, and colorectal carcinoma[9]
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Contributor Information and Disclosures
Author

Christina K Anderson, MD  Consulting Staff, Department of Dermatology, CentraCare Clinic

Christina K Anderson, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

O Fred Miller III, MD  Emeritus Director, Department of Dermatology, Geisinger Medical Center

O Fred Miller III, MD is a member of the following medical societies: American Academy of Dermatology and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Susan Cooper, MB, ChB, MD, MRCGP, FRCP  Consultant Dermatologist and Honorary Senior Clinical Lecturer, Department of Dermatology, Churchill Hospital, UK

Susan Cooper, MB, ChB, MD, MRCGP, FRCP is a member of the following medical societies: Royal College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Abby S Van Voorhees, MD  Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Merck Salary Management position; Abbott Honoraria Speaking and teaching; Amgen Honoraria Review panel membership; Centocor Honoraria Consulting; Leo Consulting; Merck None Other

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Akimoto K, Yoshikawa N, Higaki Y, Kawashima M, Imokawa G. Quantitative analysis of stratum corneum lipids in xerosis and asteatotic eczema. J Dermatol. Jan 1993;20(1):1-6. [Medline].

  2. Cork MJ, Danby S. Skin barrier breakdown: a renaissance in emollient therapy. Br J Nurs. Jul 23-Aug 12 2009;18(14):872, 874, 876-7. [Medline].

  3. Weismann K, Wadskov S, Mikkelsen HI, Knudsen L, Christensen KC, Storgaard L. Acquired zinc deficiency dermatosis in man. Arch Dermatol. Oct 1978;114(10):1509-11. [Medline].

  4. Warin AP. Eczéma craquelé as the presenting feature of myxoedema. Br J Dermatol. Sep 1973;89(3):289-91. [Medline].

  5. Greist MC, Epinette WW. Cimetidine-induced xerosis and asteatotic dermatitis. Arch Dermatol. Apr 1982;118(4):253-4. [Medline].

  6. Barker DJ, Cotterill JA. Generalized eczéma craquelé as a presenting feature of lymphoma. Br J Dermatol. Sep 1977;97(3):323-6. [Medline].

  7. Guillet MH, Schollhammer M, Sassolas B, Guillet G. Eczema craquelé as a pointer of internal malignancy--a case report. Clin Exp Dermatol. Nov 1996;21(6):431-3. [Medline].

  8. van Voorst Vader PC, Folkers E, van Rhenen DJ. Craquelé-like eruption in angioimmunoblastic lymphadenopathy. Arch Dermatol. Mar 1979;115(3):370. [Medline].

  9. Higgins EM. Eczema craquelé and internal malignancy. Clin Exp Dermatol. Jul 1997;22(4):206. [Medline].

  10. Lazar AP, Lazar P. Dry skin, water, and lubrication. Dermatol Clin. Jan 1991;9(1):45-51. [Medline].

  11. Cappiello L, Miller OF. Occlusive therapy of asteatotic dermatitis. Data presented at: Pennsylvania Academy of Dermatology: 1990.

  12. Day I, Lin AN. Use of pimecrolimus cream in disorders other than atopic dermatitis. J Cutan Med Surg. Jan-Feb 2008;12(1):17-26. [Medline].

  13. Wollina U. The role of topical calcineurin inhibitors for skin diseases other than atopic dermatitis. Am J Clin Dermatol. 2007;8(3):157-73. [Medline].

  14. Schulz P, Bunselmeyer B, Brautigam M, Luger TA. Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. Jan 2007;21(1):90-4. [Medline].

  15. Gutman AB, Kligman AM, Sciacca J, James WD. Soak and smear: a standard technique revisited. Arch Dermatol. Dec 2005;141(12):1556-9. [Medline].

  16. Burton J, Holden C. Eczema, lichenification, and prurigo. In: Textbook of Dermatology. Vol 1. 6th ed. Oxford, England: Blackwell Science; 1998:644-45.

  17. Caplan RM. Superficial hemorrhagic fissures of the skin. Arch Dermatol. Apr 1970;101(4):442-51. [Medline].

  18. Fitzpatrick T, Johnson R, Wolff K. Asteatotic Dermatitis. In: Color Atlas and Synopsis of Clinical Dermatology. 3rd ed. New York, NY: McGraw-Hill; 1997:75.

  19. Murray H, Forsey RR. Eczema craquele. Arch Dermatol. 1975;111:1536.

 
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Asteatotic dermatitis on the lower extremity.
Asteatotic dermatitis on the lower extremity.
Asteatotic dermatitis on the lower extremity.
 
 
 
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