Asteatotic eczema

Asteatotic eczema

Cause

Many who develop asteatotic eczema in old age will always have had a dry skin and a tendency to chap.

Other contributory factors include the removal of surface lipids by over-washing, the low humidity of winter and central heating, the use of diuretics, and hypothyroidism.

Presentation and course

Often unrecognized, this common and itchy pattern of eczema occurs usually on the legs of elderly pati-ents. Against a background of dry skin, a network of fine red superficial fissures creates a ‘crazy paving’ appearance (Fig. 7.27).

Investigations

None are usually needed. Very extensive cases may be part of malabsorption syndromes, zinc deficiency or internal malignancy.

Treatment

Can be cleared by the use of a mild or moderately potent topical steroid in a greasy base, and aqueous cream as a soap substitute for the area. Baths should be restricted until clearance. Thereafter, daily use of unmedicated emollients  usually prevents recurrence.