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Asteatotic eczema

OVERVIEW

What is asteatotic eczema?

Asteatotic eczema, also known as winter itch, eczema craquelé, winter eczema, xerotic dermatitis, and dry eczema, is an eczema-like dermatitis.

Asteatotic eczema can occur in multiple areas of the body, commonly affecting the skin of the lower legs, forearms, and hands, particularly the shins of elderly individuals. It presents as dry skin surface with fine cracks in the epidermis and stratum corneum, resembling fish-scale fissures with upturned edges. The skin appears light red, with more pronounced redness along the cracks, similar to "cracked porcelain," accompanied by itching. Scratching may lead to epidermal peeling, erythema, localized edema, or even bleeding. In severe cases, extensive redness, dryness, hardening, and superficial skin fissures may occur[1].

This condition can generally be alleviated by modifying bathing habits and moisturizing. Severe cases may require medication. While treatment is effective, recurrence is common in winter or low-humidity environments[2].

Is asteatotic eczema common?

It is relatively common and can occur at any age, but primarily affects the elderly[3]. Asteatotic eczema accounts for 26.8% of eczema cases in older adults, meaning that out of 1,000 elderly patients with eczema, 268 have asteatotic eczema[4].

This condition can significantly disrupt the daily lives of elderly individuals, greatly reducing their quality of life[4].

SYMPTOMS

What are the manifestations of asteatotic eczema?

Asteatotic eczema primarily presents as dry skin surface with fine cracks in the epidermis and stratum corneum, resembling fish-scale-like fissures with raised edges. The skin appears light red, with more pronounced redness at the cracks, similar to "cracked porcelain." It often causes needle-like or ant-crawling sensations accompanied by itching. Scratching may lead to epidermal peeling, erythema, localized edema, or even bleeding. In severe cases, large areas of redness, dryness, hardness, and superficial skin fissures may occur[1].

Where does asteatotic eczema commonly occur?

It frequently affects the extensor surfaces of the lower legs (anterior tibial area), but may also appear on the thighs, arms, and torso[1].

CAUSES

What are the causes of asteatotic eczema?

Asteatotic eczema is associated with excessive water loss and reduced sebum secretion due to various factors, as detailed below:

  1. Age factor: As people age, sebaceous gland secretion and water retention functions gradually decline, leading to insufficient oil and moisture on the skin surface, which triggers this condition[2].
  2. Seasonal factor: This condition is more common in winter due to dry climates and indoor heating or air conditioning, which reduce humidity and increase the likelihood of its occurrence[5].
  3. Genetic factor: Some patients with a family history have complex functional defects in the stratum corneum, impairing barrier and water retention functions, thereby causing this condition[6].
  4. Medication factor: Side effects of certain medications, such as diuretics (e.g., hydrochlorothiazide) and anti-androgen drugs (e.g., finasteride), can also lead to asteatotic eczema.
  5. Lifestyle factor: Prolonged bathing (> 30 minutes), excessively hot water (≥ 40℃), and long-term use of irritating cleansing products (containing sodium lauryl sulfate, polyethylene glycol, artificial fragrances, etc.) can damage the skin barrier and reduce sebum secretion, leading to this condition[2].
  6. Disease factor: Certain diseases, such as hypothyroidism and malignant tumors (e.g., gastric cancer, colon cancer), may also induce asteatotic eczema.

Is asteatotic eczema hereditary?

Partially. Some patients with a family history have complex functional defects in the stratum corneum, impairing barrier and water retention functions, which can lead to asteatotic eczema[6].

Is asteatotic eczema contagious?

No, it is not contagious.

The cause of asteatotic eczema is primarily the disruption of the skin barrier function due to various internal and external factors, leading to reduced stratum corneum hydration, but it is not infectious.

Can asteatotic eczema occur in children or young people?

Yes. Studies have found that the age range of patients with asteatotic eczema is trending younger, possibly due to modern lifestyle habits. Activities such as frequent hot spring baths, saunas, cosmetic use, swimming more than three times a week for over 30 minutes each time can damage the skin barrier, reduce stratum corneum hydration, and trigger this condition[2].

In children, asteatotic eczema may be related to underdeveloped skin barrier functions, sebaceous glands, and sweat glands[2].

Is the occurrence of asteatotic eczema related to seasons?

Yes. Skin tends to be drier in winter, especially with indoor heating reducing humidity, making asteatotic eczema more likely to occur[1].

Which groups are more prone to asteatotic eczema?

  1. Elderly individuals: Older adults (≥ 60 years) are more susceptible due to reduced sebaceous gland secretion and water retention functions.
  2. Those with a family history: This condition has a hereditary tendency, increasing the likelihood of occurrence in descendants.
  3. Individuals with improper bathing habits: Excessive bathing, overly hot water, and frequent use of soap can damage the skin barrier and reduce sebum secretion, making them prone to asteatotic eczema.
  4. Those taking certain medications: Long-term use of diuretics (e.g., hydrochlorothiazide) or anti-androgen drugs (e.g., finasteride) can increase the risk of asteatotic eczema due to their side effects.

DIAGNOSIS

What tests are needed for asteatotic eczema?

Which diseases can asteatotic eczema be easily confused with?

Asteatotic eczema has typical manifestations and is easy to diagnose, but it may need to be distinguished from stasis dermatitis of the lower limbs. Both conditions can present with symptoms such as scaling, redness, swelling, and itching on the lower limbs, leading to confusion. Stasis dermatitis is caused by increased venous pressure in the lower limbs, leading to tissue hypoxia and necrosis, and is often accompanied by varicose veins[1]. In contrast, asteatotic eczema results from excessive water loss and reduced sebum secretion due to various factors and does not involve varicose veins, which helps differentiate the two.

TREATMENT

How to treat asteatotic eczema?

  1. General treatment:
    • If symptoms are mild and do not affect sleep, you can apply moisturizing cream on your own to nourish the skin, provide a protective barrier, lock in moisture, and repair the skin barrier[5]. Due to differences in formulation or quality, some patients may experience allergies (such as rashes) when using moisturizers.
    • It is best to use a humidifier at home. When bathing, keep the water temperature low (around 36°C–38°C, not exceeding 40°C), shorten the duration (within 15 minutes), and use milder, weakly acidic cleansing products (pH range of 5–6) to alleviate symptoms[1].
  2. Medication: If itching is severe and affects sleep, it is recommended to seek medical treatment. Oral antipruritic drugs (such as diphenhydramine, chlorpheniramine maleate, etc.) or topical corticosteroid ointments (such as compound dexamethasone ointment, hydrocortisone butyrate cream, etc.) may be needed for relief[1].

Can asteatotic eczema be completely cured?

Asteatotic eczema cannot be cured.

Although treatment is effective, it only alleviates symptoms and cannot guarantee a permanent cure. It tends to recur in winter or low-humidity environments[1].

Is medication always necessary for asteatotic eczema?

Not necessarily.

In most cases, adjusting bathing habits (keeping water temperature around 36°C–38°C, not exceeding 40°C, limiting bathing time to under 15 minutes, and using weakly acidic cleansers with a pH range of 5–6) and applying moisturizers can improve symptoms without medication. However, if symptoms are severe (e.g., intense itching affecting sleep), medication may be required.

Which department should I visit for asteatotic eczema?

Dermatology.

DIET & LIFESTYLE

What should be paid attention to in daily life for asteatotic eczema?

  1. Apply moisturizing lotion after bathing. It is best to use a humidifier at home to maintain indoor humidity at 40%–50%. When bathing, keep the water temperature low (around 36°C–38°C, not exceeding 40°C) and limit bathing time (within 15 minutes). Use milder, weakly acidic cleansing products (pH range 5–6).
  2. Follow the doctor's instructions for medication and do not stop taking it arbitrarily.
  3. Some patients may experience irritability due to severe itching. They can choose to listen to soothing music, go outdoors more often, and maintain a cheerful mood.

What dietary precautions should patients with asteatotic eczema take?

There are no special dietary restrictions; a healthy and balanced diet is sufficient[7].

  1. When cooking, use less salt (daily intake <5g), less oil (daily intake 25–30g), fewer high-salt seasonings, and avoid pickled vegetables and meats.
  2. Do not rely solely on refined rice and wheat for staple foods. Replace some with whole grains, legumes, potatoes, pumpkin, etc.
  3. Balance meat and vegetables. Prefer white meats like chicken, duck, and fish, and eat less fatty meat. Eggs and milk are important sources of protein and other nutrients.
  4. For vegetarians, eat more beans and bean products to supplement protein.
  5. Eat plenty of fresh fruits and vegetables.
  6. Quit smoking and avoid alcohol as much as possible.

PREVENTION

How to prevent asteatotic eczema?

  1. Avoid excessively dry indoor environments (maintain humidity between 40% and 50%).
  2. Use gentler, mildly acidic bathing products (pH range of 5–6) when showering, avoid excessively hot water (around 36°C–38°C, not exceeding 40°C), and limit shower time (≤ 15 minutes).
  3. Frequently apply moisturizers or lotions after bathing to lock in skin moisture and avoid scratching.
  4. Individuals with a family history should undergo strict screening for early detection and treatment.