Summary about Disease
Xerotic eczema, also known as asteatotic eczema or eczema craquelé, is a type of eczema primarily caused by abnormally dry skin. It is characterized by dry, cracked, and itchy skin, often resembling a cracked riverbed or porcelain. This condition is more common in older adults and during the winter months when humidity is low.
Symptoms
Dry, rough, and scaly skin
Cracked skin, often resembling a cracked pavement or porcelain
Itching, which can be severe
Redness and inflammation
Small, superficial fissures (cracks) in the skin
Commonly affects the lower legs, arms, and trunk, but can occur anywhere on the body
Causes
Dry Skin: The primary cause is lack of moisture in the skin.
Low Humidity: Dry environments, especially during winter, exacerbate the condition.
Frequent Bathing/Washing: Over-washing, especially with hot water and harsh soaps, strips the skin of natural oils.
Age: Older adults have less oil production in their skin.
Certain Medications: Some diuretics or cholesterol-lowering drugs can contribute to dry skin.
Underlying Medical Conditions: Hypothyroidism and malnutrition can contribute.
Irritants: Exposure to harsh chemicals or detergents.
Medicine Used
Emollients (Moisturizers): The cornerstone of treatment. Thick creams and ointments (e.g., petroleum jelly, mineral oil, ceramide-containing creams) should be applied liberally and frequently, especially after bathing.
Topical Corticosteroids: Used to reduce inflammation and itching. Mild to moderate potency corticosteroids are generally sufficient.
Topical Calcineurin Inhibitors (TCIs): Such as tacrolimus and pimecrolimus, can be used as steroid-sparing agents.
Antihistamines: Oral antihistamines can help alleviate itching, especially at night.
Topical Antipruritics: such as calamine lotion, may provide temporary relief from itching.
Prescription Barrier Repair Creams: Containing ingredients such as ceramides and cholesterol to help restore the skin's natural barrier function.
In severe cases, phototherapy or systemic immunosuppressants may be considered, but are rarely needed for xerotic eczema alone.
Is Communicable
No, xerotic eczema is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Moisturize Regularly: Apply a thick, fragrance-free moisturizer several times a day, especially after bathing.
Use Mild Soaps: Avoid harsh, drying soaps. Opt for gentle, fragrance-free cleansers.
Limit Bathing Time: Short, lukewarm showers or baths are preferable to long, hot ones.
Pat Skin Dry: Avoid rubbing the skin vigorously after bathing.
Humidify Your Home: Use a humidifier, especially during the winter months.
Avoid Irritants: Wear gloves when using cleaning products or handling harsh chemicals.
Wear Soft Fabrics: Choose loose-fitting, breathable clothing made of cotton or other soft materials. Avoid wool or synthetic fabrics that can irritate the skin.
Stay Hydrated: Drink plenty of water to keep skin hydrated from the inside out.
How long does an outbreak last?
The duration of an outbreak varies depending on the severity of the condition and how well it is managed. With proper treatment and preventative measures, symptoms can often be controlled within a few days to weeks. Chronic or poorly managed xerotic eczema can persist for longer periods.
How is it diagnosed?
Diagnosis is usually based on a physical examination of the skin and a review of the patient's medical history. The characteristic dry, cracked appearance of the skin, along with the presence of itching, is often sufficient for diagnosis. A doctor may ask about bathing habits, skincare routines, and potential irritant exposures. In some cases, a skin biopsy may be performed to rule out other skin conditions, but this is rarely necessary for xerotic eczema.
Timeline of Symptoms
Initial Stage: Skin feels dry and tight.
Progression: Skin becomes visibly dry, flaky, and scaly. Itching begins.
Moderate Stage: Cracks appear in the skin, often resembling a cracked pavement. Redness and inflammation may be present. Itching intensifies.
Severe Stage: Deep fissures develop, which can be painful and prone to infection. Skin may become thickened and leathery due to chronic scratching (lichenification).
Important Considerations
Consistency is Key: Regular moisturizing is crucial for managing xerotic eczema.
Prevention is Better Than Cure: Focus on preventing dryness before it starts.
Complications: Persistent scratching can lead to skin thickening, lichenification, and secondary bacterial infections.
Differential Diagnosis: Rule out other conditions such as atopic dermatitis, psoriasis, and contact dermatitis.
Consult a Dermatologist: If symptoms are severe, persistent, or do not respond to over-the-counter treatments, consult a dermatologist for further evaluation and management.
Lifestyle Adjustments: Identifying and modifying lifestyle factors that contribute to dry skin (e.g., bathing habits, clothing choices) can help prevent recurrences.