eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Asteatotic Eczema: Treatment & Medication

Author: Christina K Anderson, MD, Consulting Staff, Department of Dermatology, Center Care Clinic
Coauthor(s): O Fred Miller III, MD, Emeritus Director, Department of Dermatology, Geisinger Medical Center; Susan Cooper, MB, ChB, MD, MRCGP, MRCP, Consultant Dermatologist and Honorary senior clinical lecturer Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
Contributor Information and Disclosures

Updated: Sep 11, 2009

Treatment

Medical Care

Patients should follow the methods listed below to improve the condition.10

  • Take short baths with decreased water temperature.
  • Eliminate or reduce the use of soap on the involved areas.
  • Avoid harsh skin cleansers.
  • Apply petrolatum-based emollients following bathing, and use moisturizing agents liberally.
  • Apply topical steroid ointments with or without polyethylene occlusion. Note that steroids can thin the cutaneous barrier and lower the threshold for further insults that lead to dermatitis, especially in elderly patients.
  • Use humidifiers.

Medication

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 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.

Topical steroids

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 acetonide (Aristocort)

For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Available in ointment (0.1%) and cream (0.025%, 0.1%, 0.5%).

Adult

Apply thin film bid/tid to response

Pediatric

Apply as in adults

Documented hypersensitivity; fungal, viral, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use causes striae and atrophy; do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria

More on Asteatotic Eczema

Overview: Asteatotic Eczema
Differential Diagnoses & Workup: Asteatotic Eczema
Treatment & Medication: Asteatotic Eczema
Follow-up: Asteatotic Eczema
Multimedia: Asteatotic Eczema
References
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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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Further Reading

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Keywords

asteatotic eczema, asteatotic dermatitis, eczema craquelé, asteatosis, eczema craquelatum, xerotic eczema, winter itch, eczema hiemalis, eczema fendille, etat craquelé

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Contributor Information and Disclosures

Author

Christina K Anderson, MD, Consulting Staff, Department of Dermatology, Center Care 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, MRCP, Consultant Dermatologist and Honorary senior clinical lecturer Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
Susan Cooper, MB, ChB, MD, MRCGP, MRCP is a member of the following medical societies: Royal College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

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; Genentech Honoraria Consulting; Incyte Grant/research funds Other; Warner Chilcott Honoraria Consulting; Merck Salary Management position; Abbott  Speaking and teaching

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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