DermatologyTier 2Disease (DEADMAN)

Asteatotic eczema

Description

Asteatotic eczema (eczema craquele) - a form of eczema from skin dryness/reduced lipid barrier function, classically affecting older adults, producing a characteristic "crazy paving" cracked appearance, particularly on the lower legs

Epidemiology

Common in older adults, particularly in winter (low humidity environments) and with frequent hot showering/bathing or harsh soap use that strips natural skin lipids

Aetiopathogenesis

Age-related decline in skin barrier lipid production, compounded by environmental drying factors (low humidity, hot water, harsh cleansers) and sometimes diuretic use (reducing skin hydration) - disrupts the stratum corneum's normal barrier function, allowing transepidermal water loss and producing the characteristic dry, cracked, erythematous skin

Diagnosis

Characteristic "crazy paving" or "dried riverbed" pattern of fine cracking/fissuring on a background of dry, erythematous, scaly skin, classically on the shins/lower legs; can be itchy and, if fissures are deep, painful

Management

Emollients (regular, liberal use) are the cornerstone of both treatment and prevention - applied at least daily, ideally after bathing while skin is still slightly damp to lock in moisture
Avoid harsh soap/hot water; shorter, cooler showers and soap-free cleansers reduce further lipid stripping
Topical corticosteroids for more inflamed/itchy areas, used short-term alongside ongoing emollient use

Associations

Xerosis (dry skin generally), older age, diuretic use, winter/low-humidity environments, secondary bacterial infection if fissures become infected

Natural history & complications

Asteatotic eczema is largely a preventable/modifiable condition once the environmental and behavioural drying factors are addressed - patient education on bathing habits and consistent emollient use is often as important as any topical medication prescribed

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