Asteatotic Eczema Medication

  • Author: Christina K Anderson, MD; Chief Editor: William D James, MD  more...
 
Updated: Sep 01, 2015
 

Medication Summary

Topical steroid ointments with 24- to 48-hour occlusion with polyethylene or Unna boots are the treatment of choice for the rapid resolution of asteatotic dermatitis.[11] Unna boots with steroid cream or ointment add to therapeutic efficacy and ease of care, especially in the nursing home population. Boots can be left intact usually for 3-5 days. Many patients heal with mild topical steroids (class III-VI) alone, depending on the severity of the dermatitis, the patient's compliance with treatment, and the reduction in the use of soap and hot water to the involved areas. Several studies have reported on the successful use of pimecrolimus or tacrolimus cream in conditions other than atopic dermatitis, including seborrheic dermatitis and asteatotic eczema, among others. However, more research is needed to clarify the role of topical calcineurin inhibitors in treating these other disorders.[12, 13, 14]

The liberal use of moisturizers, especially petrolatum-based preparations, alone or in combination with topical steroids for mild cases of asteatotic dermatitis is recommended.

The soak-and-smear method of hydrating the skin by bathing or soaking the affected area followed by immediate application of steroid ointment once daily has been shown to clear more that 90% of patients in 4-14 days. This is best performed at night.[15]

Note that steroids can thin the cutaneous barrier and lower the threshold for further insults that lead to dermatitis, especially in elderly patients.

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Topical steroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Triamcinolone (Aristocort)

 

Triamcinolone is for inflammatory dermatosis responsive to steroids; it decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Triamcinolone is available in ointment (0.1%) and cream (0.025%, 0.1%, 0.5%).

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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)

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

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

Disclosure: Nothing to disclose.

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, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, Women's Dermatologic Society, National Psoriasis Foundation, American Medical Association, Phi Beta Kappa, Sigma Xi

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbott for consulting; Partner received salary from Merck for management position; Received honoraria from Abbott for speaking and teaching; Received honoraria from Amgen for review panel membership; Received honoraria from Centocor for consulting; Received honoraria from Leo for consulting; Received none from Merck for other.

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. 1993 Jan. 20(1):1-6. [Medline].

  2. Cork MJ, Danby S. Skin barrier breakdown: a renaissance in emollient therapy. Br J Nurs. 2009 Jul 23-Aug 12. 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. 1978 Oct. 114(10):1509-11. [Medline].

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

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

  6. Barker DJ, Cotterill JA. Generalized eczéma craquelé as a presenting feature of lymphoma. Br J Dermatol. 1977 Sep. 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. 1996 Nov. 21(6):431-3. [Medline].

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

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

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

  11. Cappiello L, Miller OF. Occlusive therapy of asteatotic dermatitis. 1990.

  12. Day I, Lin AN. Use of pimecrolimus cream in disorders other than atopic dermatitis. J Cutan Med Surg. 2008 Jan-Feb. 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. 2007 Jan. 21(1):90-4. [Medline].

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

 
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