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Asteatotic eczema is a type of itchy eczema characterized by dry, cracked, scaling, and often inflamed skin. It is also known as dry eczema or eczema craquelé, in reference to its cracked appearance.
Asteatotic eczema often shows up as dry, flaky, discolored patches on the lower legs, although it can occur on any area of the skin. On lighter skin, these patches tend to look reddish, while on darker skin, they may appear dark, ashen, or gray. Asteatotic eczema is most common in adults older than 60, but younger people can also have it.
Asteatotic eczema can often be prevented and controlled with at-home management. It can take time to find the right combination of treatments, so be sure to speak with your doctor about your options.
This article will show you asteatotic eczema pictures while explaining some common causes, symptoms, and treatments for this condition.
Asteatotic eczema is primarily caused by excessive moisture loss from the outer 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 — such as bathing with harsh soaps and detergents.
Most people develop asteatotic eczema symptoms during the winter when the air is dry and indoor heating is common. Both of these factors, as well as drastic changes in temperature, contribute to dry skin and “winter itch.”
Asteatotic eczema has been linked to a lack of zinc and some essential fatty acids in the diet. While this is rare, it’s worth discussing with your health care provider.
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:
Less commonly, asteatotic eczema can be caused by radiation exposure or hypothyroidism (underactive thyroid). Asteatotic eczema can also develop as a complication of ichthyosis, a group of skin disorders characterized by dry, scaly, or thickened skin.
Asteatotic eczema is the third most common type of itchy eczema, after 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.
Although asteatotic eczema shares many symptoms with other types of eczema, it has some distinct symptoms of its own.
A distinctive feature of asteatotic eczema, “crazy paving” refers to the skin’s appearance when it cracks in a pattern with discolored bands separating diamond-shaped plates of skin. This gives the lower legs (or other affected areas) the appearance of fractured pavement or porcelain.
These paved 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.
Itchiness is commonly the most frustrating symptom of asteatotic eczema, sometimes causing sleep disturbances and increased stress. Scratching damages the top layer of the skin, leaving you exposed to secondary bacterial infections.
“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.
Inflammatory chemicals produced by the immune system, including histamine, may cause a reaction that leads to inflammation.
In severe cases, asteatotic eczema can cause secondary dermatitis with swelling, skin redness or discoloration, and blistering. At this stage, localized eczema on the lower legs may become widespread.
Asteatotic eczema may also cause mental health or other general health symptoms.
It’s 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 can cause the immune system to produce more inflammatory chemicals, worsening your symptoms.
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.
Asteatotic eczema can usually be diagnosed by its appearance without the need for tests. However, your doctor may order a skin biopsy if they are 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.
Your doctor may also order thyroid function tests if you’re showing signs that could suggest hypothyroidism, such as weight gain, dry and thinning hair, 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.
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.
Emollients, moisturizers used to soften the skin, are the first line of asteatotic eczema treatment. Emollients are available over the counter and as prescriptions. Emollients vary 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 — also called topical corticosteroids or cortisone — are a common treatment for skin inflammation from eczema and other conditions. They work by:
Topical steroids come in creams, gels, and ointments. While mild over-the-counter 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.
Your dermatologist may recommend other nonsteroidal topical creams. Always follow the instructions to avoid overuse and worsening your skin condition.
Antihistamines are commonly used to relieve itching and swelling in asteatotic eczema. They are available over the counter and may be recommended by your doctor, but they don’t generally require a prescription. Many are sedating, so they are most helpful as a sleep aid to reduce nighttime itching.
Many of the problems associated with dry skin and asteatotic eczema can be managed at home.
The first step to protecting your skin is to identify the causes of your dry skin. Common irritating and drying products include:
Keep track of what products you use on your skin and make note of any changes in your symptoms.
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 it at other times you feel your skin becoming 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.
Frequent and prolonged baths strip the skin of its natural oils, leading to dryness. Avoid taking long baths. Also, use warm water, 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.
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.
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 53,000 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.
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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 MyHealthTeam with more than five years of experience writing about a diverse range of subjects.
Learn more about him here.
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