Dry (asteatotic) eczema is an eczematous dermatitis caused by excessive dryness and cracking of skin.
This dry eczema is also called «eczema craquele».
Causes of dry eczema
Dry (asteatotic) 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 affected equally. Disease is more common among patients with atopic diathesis, especially in later years of life. Most patients had before in history similar outbreaks. Disease peak is in late winter and it decreases in summer, this is especially true for countries with dry cold climate. Any area of skin can be affected, although most often disease is localized in lower limbs. At the beginning of the disease, patients often notice that their skin looks dry and feel dryness. As disease progresses, increasing inflammation and itching are most severe symptoms. Patients may feel a burning sensation, and in severe cases there are cracks and peels.
Symptoms of dry eczema
Symptoms of dry eczema are typical of subacute eczematous dermatitis. Conjunctival with accentuated skin pattern is hallmark of disease at outset. Inflammation is initially weak, but becomes more pronounced over time. Weak erythema, with blurred boundaries progresses in bright red, sharply eczematous papules that coalesce into broad plaques. Vesicles usually are not formed, and excoriations practically are almost always present. Dry, fine desquamation progresses with formation of thin surface cracks to condition, known as «eczema craquele», when skin becomes like cracked porcelain or dry riverbed. Skin is very dry with fine and deep cracks. It can be painful. Progressing, dry eczema becomes acute, with weeping, crusting and intense erythema.
Seasonal recurrence is expected in winter months. Weak seasonal outbreaks with itching and xerosis are improved with warm weather and constant use of mitigation products. Active sub-acute inflammation generally responds to ointments with corticosteroid of average potency and improves with onset of warm season. Severe localized outbreak with acute symptoms such as oozing and crusts, also responds to individual topical treatment, which will be discussed below. Severe outbreaks should be treated aggressively, because they can be generalized.
Diagnosis of dry eczema
Symptoms of dry eczema are eloquent enough, so skin biopsy is rarely needed for diagnosis. Skin biopsy confirms presence of epidermal spongiosis with dermal inflammation and often secondary inpetiginization.
Differential diagnosis
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 few dermatoses simultaneously. Second dermatosis may mask or worsen the primary eczematous process. Irritant and allergic contact dermatitis can develop as result of patient's own efforts at self-healing. Patient should be asked what he applies to the affected areas. Stasis dermatitis usually affects lower leg in elderly patients. In history venous insufficiency and leg edema, and presence of brown pigmentation (hemosiderosis) of skin are recorded.
Treatment of dry eczema
Treatment of dry eczema depends on the stage of dry eczema (acute, subacute or chronic) and degree of inflammation. For treatment of xerosis measures for sensitive skin are taken, namely, limited use of only mild soap and abundant use of emollients. As emollient containing no preservatives, petrolatum can be recommended, although patients do not always agree to apply it. Moisturizers containing lactic acid, urea or glycolic acid, may also be useful. Early inflammation is best to be treated by external corticosteroid with medium potency primarily on ointment bases.
Treatment of dry eczema should be continued until resolution of erythema and flaking. Abundant use of emollients should be continued as prevention of recurrence. It is best to apply emollients of soothing actions that do not contain aromatic additives. Localized outbreaks with symptoms of acute eczematous process, such as oozing and crusting should first be treated as a severe eczema. Patients require careful monitoring during this stage as localized outbreaks may become generalized. In case of recurrent acute episodes dermatologist must conduct survey to determine presence of allergic contact dermatitis. Wet compresses with solution of Burov and external corticosteroid of medium potency based on creams are effective for sanitation of wounds and reducing inflammation. Systemic antibiotics may be indicated for secondary inpetiginization, being witnessed by sticky honey-colored crust. When oozing, inflammation and crusting regress, moist compresses should be canceled to avoid excessive drying of affected areas. Ointments with corticosteroid of medium potency (group II or IV) should be continued until flushing and peeling stop, approximately for 2-3 weeks. Then to reduce recurrence measures for sensitive skin are applied, including emollients. Systemic corticosteroids for treatment of dry eczema are rarely used.