Asteatotic Eczema Clinical Presentation

Updated: Aug 07, 2019
  • Author: Christina K Anderson, MD; Chief Editor: William D James, MD  more...
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Presentation

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 Examination

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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