Asteatotic Eczema (Eczema craquelé)

  • Dry skin in patients > 60 years old
  • Exogenous causes:  
    • Dry climate
    • Low humidity
    • Water exposure
    • Soaps
    • Surfactants
    • Malnutrition
    • Renal insufficiency/ hemodialysis
  • -Endogenous causes: 
    • Aging (most common cause)
    • Atopic dermatitis
    • Ichthyosis vulgaris

  • Not due to decreased sebum production
  • But due to dysfunction of stratum corneum:
    • Decreased intercellular lipids + presence of corneodesmosomes + premature expression of involucrin = corneocyte retention and impaired barrier
    • Decreased water-binding capacity + pliability leading to crack formation

  • Xerosis 
    • Shins
    • Thighs
    • Trunk 
    • Spares the face, neck, palms and soles
  • Fine branny scales 
  • Advanced disease:
    • Eczema craquelé pattern 
    • Erythema
    • Oozing
    • Crusting
    • Excoriations
  • Vesicles and lichenification (rare)

If widespread and refractory to treatment: 

  •  Lymphoma association (rarely)

  • Compact and slightly irregular stratum corneum

  • Eliminate aggravating factors
  • Emollients (regularly)
  • Topical corticosteroid ointment
  • Topical calcineurin inhibitors