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.^[16]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.^{[17, 18, 19]}

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.^[14]

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

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)

View full drug information

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%).

Questions

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Cassler NM, Burris AM, Nguyen JC. Asteatotic eczema in hypoesthetic skin: a case series. JAMA Dermatol. 2014 Oct. 150 (10):1088-90. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Yang CS, Lott JP, Bunick CG, Bolognia JL. Eczema craquelé associated with nephrotic syndrome. JAAD Case Rep. 2016 May. 2 (3):241-3. [QxMD MEDLINE Link].
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Barker DJ, Cotterill JA. Generalized eczéma craquelé as a presenting feature of lymphoma. Br J Dermatol. 1977 Sep. 97(3):323-6. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
van Voorst Vader PC, Folkers E, van Rhenen DJ. Craquelé-like eruption in angioimmunoblastic lymphadenopathy. Arch Dermatol. 1979 Mar. 115(3):370. [QxMD MEDLINE Link].
Higgins EM. Eczema craquelé and internal malignancy. Clin Exp Dermatol. 1997 Jul. 22(4):206. [QxMD MEDLINE Link].
Lazar AP, Lazar P. Dry skin, water, and lubrication. Dermatol Clin. 1991 Jan. 9(1):45-51. [QxMD MEDLINE Link].
Gutman AB, Kligman AM, Sciacca J, James WD. Soak and smear: a standard technique revisited. Arch Dermatol. 2005 Dec. 141(12):1556-9. [QxMD MEDLINE Link].
Avila C, Massick S, Kaffenberger BH, Kwatra SG, Bechtel M. Cannabinoids for the treatment of chronic pruritus: A review. J Am Acad Dermatol. 2020 May. 82 (5):1205-1212. [QxMD MEDLINE Link].
Cappiello L, Miller OF. Occlusive therapy of asteatotic dermatitis. 1990.
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. [QxMD MEDLINE Link].
Wollina U. The role of topical calcineurin inhibitors for skin diseases other than atopic dermatitis. Am J Clin Dermatol. 2007. 8(3):157-73. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

Media Gallery

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

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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, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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, The Scientific Research Honor Society

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.