Dry eczema

Dry (astetotic) eczema is an eczematous dermatitis caused by excessive dryness and cracking of the skin.

This dry eczema is also called “eczema craquele”.

[1], [2], [3], [4]

Epidemiology

The disease is more common among patients with atopic diathesis, especially in the later years of life. Most patients with a history of previously had similar outbreaks of the disease. The incidence peaks towards the end of winter and decreases in summer, this is especially true for countries with a dry, cold climate.

[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]

Causes of the dry eczema

Dry (asteototic) eczema is a form of subacute eczematous dermatitis, which tends to slow chronic course with seasonal outbreaks in winter due to low humidity. Men and women are equally affected. Any part of the skin can be affected, although most often the disease is localized on the lower limbs. At the onset of the disease, patients often notice that their skin looks dry and they feel dry. As the disease progresses, itching and increasing inflammation become the most pronounced symptoms. Patients may feel burning, and in severe cases cracks and crusts form.

[16], [17], [18], [19]

Symptoms of the dry eczema

Symptoms of dry eczema are typical for subacute eczematous dermatitis. Xerosis with an accentuated skin pattern is a characteristic feature from the very beginning of the disease. Inflammation at first weak, but over time becomes more pronounced. Weak, with blurred borders, erythema progresses to bright red, acute eczematous papules, which merge into broad plaques. Vesicles are usually not formed, and excoriations are almost always present. Dry, thin desquamation progresses with the formation of thin surface cracks to a picture known as “eczema craquele”, when the skin looks like cracked porcelain or a dry river bed. The skin is very dry with small and deep cracks. She can be painful. While progressing, dry eczema becomes acute, with weeping, crusting and intense erythema.

Seasonal relapses during the winter months should be expected. Weak seasonal outbreaks with itching and xerosis improve with warm weather and with the constant use of emollients. Active subacute inflammation usually reacts to ointments with a corticosteroid of moderate potency, and also improves with the onset of the warm season. Severe localized outbreaks with acute symptoms, such as weeping and crusts, also respond to individual external therapy, which will be discussed further. Severe outbreaks should be treated aggressively, as they may become generalized.

Diagnostics of the dry eczema

Symptoms of dry eczema are quite eloquent, so skin biopsy is rarely needed for diagnosis. A skin biopsy confirms the presence of epidermal spongiosis with inflammation of the dermis and often secondary impetiginization.

[20], [21]

Differential diagnosis

The differential diagnosis includes other subacute eczematous dermatoses, such as congestive dermatitis, irritant contact dermatitis, atopic dermatitis, allergic contact dermatitis, and cellulitis. There may be signs of several dermatoses at the same time. The second dermatosis can mask or worsen the primary eczematous process. Irritant and allergic contact dermatitis may develop as a result of the patient’s own self-healing efforts. The patient should be asked about what he applies to the affected areas. Congestive dermatitis usually affects the lower legs in elderly patients. A history of venous insufficiency and swelling of the legs, as well as the presence of brown pigmentation (hemosiderosis) of the skin.

[22], [23], [24], [25], [26], [27]

Treatment of the dry eczema

Treatment of dry eczema depends on the stage of dry eczema (acute, subacute or chronic) and the degree of inflammation. For the treatment of xerosis, measures are provided for sensitive skin, namely: limited use of only mild soap and abundant use of emollients. Vaseline can be recommended as an emollient containing no preservatives, although patients do not always agree to use it. Moisturizers containing lactic acid, urea, or glycolic acid may also be helpful. Early inflammation is best treated with external corticosteroids of moderate potency, mainly on an ointment base.

Treatment of dry eczema should continue until resolution of erythema and desquamation. Abundant use of emollients should be continued as prevention of relapses. It is best to apply emollient calming action, not containing aromatic additives. Localized outbreaks with signs of acute eczematous process, such as weeping and crusting, should first be treated as acute eczema. Patients require careful monitoring during this stage, as localized outbreaks can become generalized. In recurrent acute outbreaks, the dermatologist should conduct an examination for the presence of allergic contact dermatitis. Wet compresses with a solution of Burov and an external corticosteroid of medium strength action based on a cream are effective for debridement of the wound and reduction of inflammation. Systemic antibiotics may be indicated for secondary impetiginization, as indicated by sticky peels of the color of honey. When oozing, inflammation and crust formation regress, wet compresses should be canceled to avoid excessive drying of the affected areas. Medium-strength ointments with corticosteroids (groups II or IV) should continue to be applied until hyperemia and flaking take place, about 2-3 weeks. Then, to reduce the recurrence, care measures are taken for sensitive skin, including emollients. Systemic corticosteroids are rarely used to treat dry eczema.