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Asteatotic Eczema: What You Need To Know

Posted on March 15, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Max Mugambi

Asteatotic eczema is a type of pruritic (itchy) eczema characterized by dry, cracked, scaling, and often inflamed skin. It is also known as xerotic (dry) eczema or eczema craquelé, in reference to its cracked appearance.

Asteatotic eczema often presents with dry, flaky, discolored patches on the lower legs, although it can occur on any area of the skin. The patches are commonly reddish on lighter skin and can appear dark, ashen, or gray on darker skin. Asteatotic eczema is most commonly seen in adults in their 60s, but younger people in their 20s can also be affected.

Asteatotic eczema has a variety of treatment options and can often be prevented and controlled with at-home management. It can take time to find the right combination of treatments for your particular needs, so be sure to speak with your doctor about your options.

“I use a humidifier. I take antihistamines. None of it helps. My itching is uncontrollable, and I just don't know what else to do,” wrote a member of MyEczemaTeam.

What Causes Asteatotic Eczema?

Asteatotic eczema is mainly caused by excessive loss of moisture from the surface layer of the skin. This water loss occurs when the skin barrier is damaged by environmental factors, such as low humidity or excessive water exposure — including from bathing, especially with harsh soaps and detergents containing irritating chemicals.

Most people develop asteatotic eczema symptoms during the winter when the air is dry and indoor heating is commonplace. Both of these factors, as well as drastic changes in temperature, contribute to dry skin and the associated “winter itch.”

Some medications, such as diuretics, retinoids, and protein kinase inhibitors, can also reduce the skin’s moisture content and worsen dryness.

Other contributing causes include:

  • Decreased sebaceous glands (oil-producing glands)
  • Decreased sweat glands
  • Frequent bathing in hot water
  • Friction
  • Using harsh cleansers

Less commonly, asteatotic eczema can be caused by radiation, hypothyroidism (underactive thyroid), and lack of certain key nutrients, such as zinc and essential fatty acids.

Asteatotic eczema can also develop as a complication of ichthyosis, a group of inherited or acquired skin disorders characterized by dry, scaly, or thickened skin.

Prevalence of Asteatotic Eczema

Asteatotic eczema ranks among the top three types of eczema characterized by severe itching, closely following atopic dermatitis and generalized eczema.

Although asteatotic eczema can affect anyone regardless of age, it’s the most common form of eczema affecting the elderly. It is typically seen in people over 60 years old, with the median age of those affected being 69 years.

Primary Asteatotic Eczema Symptoms

Although asteatotic eczema shares many of its symptoms with other types of eczema, it has few distinct symptoms of its own.

Crazy-Paving Pattern

A distinctive feature of asteatotic eczema, “crazy paving” refers to the skin’s appearance when it cracks in a pattern, with sometimes discolored bands separating diamond-shaped plates of skin. This gives the lower legs (or other affected areas) the appearance of fractured pavement or porcelain.


Asteatotic eczema (DermNetNZ)

These patterns may start on one area of the skin, such as a shin, but quickly spread to the skin on both lower legs. In some cases, scratch marks may also appear.

Itchy Skin

Itchiness is commonly the most frustrating symptom of asteatotic eczema, sometimes causing sleep disturbances and increased stress. Scratching the dry skin damages the top level of the skin, leaving you exposed to secondary bacterial infections.

Inflammation

Inflammatory chemicals produced by the immune system, including histamine, may cause a reaction that leads to inflammation.

Secondary Dermatitis

In severe cases, asteatotic eczema can cause secondary dermatitis with swelling, generalized redness, and surface blistering. At this stage, localized eczema on the lower legs becomes widespread.

Secondary Symptoms

Asteatotic eczema may also cause emotional or more generalized symptoms.

Stress

It is natural to experience stress when living with a skin condition. Aside from its visible effects, the physical symptoms of asteatotic eczema can contribute to anxiety and stress. This could cause the immune system to produce more inflammatory chemicals, worsening your symptoms.

Disrupted Sleep

Due to the psychological and physical impacts of the condition, almost all forms of eczema can cause sleep deprivation. Asteatotic eczema is no different — especially since persistent itchiness can make sleeping difficult.

How is Asteatotic Eczema Diagnosed?

In the majority of cases, asteatotic eczema can be diagnosed by its appearance without the need for tests. However, a skin biopsy may be performed if your doctor is uncertain about your diagnosis. A skin biopsy involves taking a small sample of tissue and examining it under a microscope to determine what’s causing your symptoms.

Thyroid function tests may also be performed if you’re showing signs that could suggest hypothyroidism, such as weight gain, dry and thinning hair, slowness, and lethargy.

A more thorough investigation may be necessary if your symptoms seem to arise from an internal cause. These include excessive scaling, weight loss, fever, and a general feeling of sickness (malaise).

Treatments for Asteatotic Eczema

The primary treatment for asteatotic eczema is to keep the skin hydrated. This may involve using medications and making lifestyle adjustments to prevent the skin from drying out and to replenish lost moisture.

Emollients

Emollients are moisturizers used to soften the skin. These are the first line of treatment for asteatotic eczema. Emollients are available over the counter and as prescriptions. There is a wide range of emollients available, varying by their level of thickness. Generally, the dryer your skin, the thicker the emollient you should use. Ointments tend to be the thickest, followed by creams, then lotions. Moisturizers with ammonium lactate, urea, and salicylic acid may help smooth the skin.

Topical Steroids

Topical steroids — also called topical corticosteroids or cortisone — are a common treatment for skin inflammation in eczema and other conditions. They work by:

  • Decreasing inflammation
  • Suppressing immune activity
  • Narrowing the blood vessels
  • Inhibiting cell growth

Topical steroids come in creams, gels, and ointments. While mild over-the-counter (OTC) topical steroid creams or ointments may be sufficient, you may need a prescription option for severe asteatotic eczema. Stronger steroid creams are more effective at stopping inflammation and itch, but they also carry the risk of thinning the skin over time.

Antihistamines

Antihistamines are commonly used to relieve itching and swelling in asteatotic eczema. They are available OTC and may be recommended by your doctor, but they don’t generally require a prescription. Many are sedating, so they are most helpful in serving as a sleep aid by reducing nighttime itching.

Asteatotic Eczema Home Remedies

Many of the problems associated with dry skin and asteatotic eczema can be managed at home.

Track Your Triggers

The first step to protecting your skin is to identify the causes of your dry skin. Common irritating and drying products include:

  • Soaps
  • Detergents
  • Hair products
  • Degreasing agents

Keep track of what products you use on your skin and make note of any worsening or improvements in your symptoms.

Moisturize Often

Moisturizers can help relieve dryness and scaling. Moisturizer works best if applied immediately after taking a bath when the skin is still damp and soft. You should also apply at other times if you feel your skin becoming particularly dry.

Generally, thicker moisturizers and emollients, such as petroleum jelly or oily creams, can be used several times a day when your skin is at its driest. After a few days, thinner moisturizers and creams may be sufficient.

Bathe Less Frequently

Frequent and prolonged baths strip the skin of its natural oils, leading to dryness. Avoid taking long, frequent baths. Additionally, use warm water for your baths, as hot water can also contribute to skin dryness. Using a gentle skin cleanser rather than a harsher soap can minimize the drying of your skin.

Keep the Indoor Air Humid

Use a humidifier in your home or office during the winter months when the air is cold and dry. In the winter, you should also avoid sitting too close to heat sources, such as radiators, as this can further dry your skin out.

Find Support

Living with a condition like asteatotic eczema can be challenging and isolating — especially if you don’t know anyone else going through it. MyEczemaTeam is a community of more than 34,000 people living with eczema and their loved ones. When you join, you become part of a team of people learning and encouraging each other to live well with eczema.

Have you had asteatotic eczema? How have you managed the itch? Share your experiences in the comments below, or start a conversation on MyEczemaTeam.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Max Mugambi is a copywriter at MyHealthTeams with more than five years of experience writing about a diverse range of subjects. Learn more about him here.

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