Get the details on this distinct-looking type of atopic dermatitis, including what causes it and how you can get rid of it.
If your eczema comes with little cracks in the surface of your skin, what you’re dealing with is likely asteatotic eczema, a subtype of the chronic inflammatory condition that is characterized by fissures in the skin that resemble a cracked desert floor. It’s just one of the many kinds of eczema out there, but also one you should pay close attention to, says Ryan Turner, M.D., an assistant professor of dermatology at the Albert Einstein College of Medicine in New York City. “In severe cases [asteatotic eczema] becomes painful, and the cracks can let bacteria into the skin and lead to infection,” says Dr. Turner.
In very rare cases, this form of eczema has even been linked to malignant skin cancer, so symptoms are never something to ignore. Here’s what experts want you to know about acteatotic eczema.
Asteatotic Eczema, Explained
Asteatotic eczema occurs when the skin has become so dry that it splits. Skin texture in someone with asteatotic eczema is sometimes referred to as "crazy paving" and the cracks typically appear in polygonal forms (a shape having at least three straight sides like a triangle, square, or rectangle) or in curved lines, according to the National Library of Medicine. It also goes by winter eczema, xerotic eczema, and eczema craquelé (a French term that Sandy Skotnicki, M.D., an assistant professor of dermatology and occupational and environmental health at the University of Toronto, says is a reference to the fractured look of the skin).
“Eczema, as it is classically thought of, develops in childhood and can persist into adulthood,” says Dr. Turner. Asteatotic eczema, on the other hand, more commonly develops in adults. And while eczema typically appears as pink, itchy, dry patches distributed all over the body, the asteatotic type is characterized by rough, cracked, scaly skin frequently on the lower legs (though it can also appear on your thighs and torso), he adds. According to research published in the journal Acta Dermatovenerologica Croatica, asteatotic eczema is the most common type of eczema found in the elderly, who naturally have drier skin than younger patients. Of the 240 people with eczema over 65 in the study who were followed over a one-year period, the prevalence of asteatotic eczema was 26.9%.
Symptoms of Asteatotic Eczema
The first sign of asteatotic eczema is xerosis, which means dry skin. The dryness causes the skin’s protective barrier to become compromised, eventually weakening and showing signs of damage. This leads to additional symptoms. How do you know if you have asteatotic eczema? It’s best to consult with your dermatologist for a comprehensive exam. But, according to the National Eczema Society, these are your clues that your xerosis may have progressed to asteatotic eczema:
Xerosis (dry skin)
Cracking
Extremely scaly
Inflammation
Redness
Signs of Xerosis (Dry Skin)
Since xerosis precedes eczema, this first symptoms you may be aware of is dry skin. According to the Cleveland Clinic, signs of xerosis include skin that is:
Flaky
Itchy
Lighter or darker than your normal skin tone
Rough
Slightly scaly
Tight
Why Do People Get Asteatotic Eczema?
Many factors can contribute to the development of the condition, including:
Environmental Causes
“Air pollution, lower humidity, cold weather, and frequent hot showers can all be contributing factors that flare eczema,” says Dr. Turner. These triggers inflame the skin, compromise the skin barrier, and lead to more dryness, all of which can contribute to the development of asteatotic eczema.
Underlying Causes
Underlying health conditions can contribute to the development or worsening of asteatotic eczema by affecting the skin's ability to retain moisture and maintain its natural barrier function, says Dr. Turner. Here's how underlying health conditions can play a role:
Hypothyroidism: An underactive thyroid gland can lead to changes in skin texture and moisture content.
Diabetes: Diabetes can affect blood circulation and nerve function, which can impact skin health and contribute to the development of asteatotic eczema.
Autoimmune Disorders: Autoimmune conditions like Sjögren's syndrome, which affects moisture-producing glands, can result in dry skin and increase the risk of asteatotic eczema.
Kidney and Liver Disorders: Conditions affecting the kidneys and liver can disrupt fluid balance and metabolism, potentially leading to dry skin and compromised skin barrier function.
Inflammatory Conditions: Certain inflammatory conditions, such as psoriasis or atopic dermatitis, can increase the risk of asteatotic eczema by contributing to skin inflammation and disruption of the skin's moisture-retaining capabilities.
Nutrient Deficiencies
According to the National Library of Medicine, the condition has been linked to low levels of zinc and essential fatty acids, both of which can lead to drier skin and vulnerability to skin conditions like asteatotic eczema.
Medications
Certain medications may increase the risk of developing asteatotic eczema. For example, Dr. Skotnicki points out, “Some patients are on lipid-lowering drugs called statins [for high cholesterol and blood pressure], which can lead to more dry skin.” And Dr. Turner points to other skin-drying medications like oral retinoids and diuretics as possible contributors.
Risk Factors
The risk factors, says Dr. Skotnicki, for asteatotic eczema (beyond having skin that is prone to eczema and irritation to start with) include:
Older Age: “This form of eczema increases with age as our skin’s natural oils decrease, leading to dry, cracked skin,” Dr. Skotnicki explains.
Lifestyle: This could include living in drier climates or over washing with harsh soap bars or taking long showers or baths in hot water.
Occupation: Dr. Skotnicki points out that occupations that require frequent bathing or showering—like personal trainers and lifeguards—are more prone to this type of eczema.
Tips for Dealing With Asteatotic Eczema at Home
Anyone dealing with asteatotic eczema should practice good general eczema care, according to Dr. Skotnicki. This includes using a humidifier in the rooms you spend a lot of time in as well as incorporating smart bathing techniques that won’t dry out your skin, which include:
Taking short, lukewarm showers. Too-hot water pulls natural oils from your skin.
Avoiding irritating fragrances in cleansers and laundry detergents.
Immediately applying moisturizers with ceramides and other emollients that help replace the skin’s decreased or lost lipid layer.
Treatment Options
Asteatotic eczema can be treated much like other types of eczema, with a combination of any of these prescription and over-the-counter options:
Calcineurin inhibitors suppress the activation of certain immune system cells. Example include Protopic (tacrolimus) and Elidel (pimecrolimus).
Moisturizers and emollients
N-palmitoylethanolamine (PEA) and N-acetylethanolamine (AEA) are phospholipids related to the endocannabinoid system. Research in Clinical Interventions in Aging shows these meds may improve skin barrier function when added to emollients.
Oral antihistamines like Zyrtec (cetirizine) or Claratin (loratadine) help control itch.
Phosphodiesterase inhibitors like crisaborole and pimecrolimus cream can curb itch.
Topical medications like steroids help control inflammation.
In addition, lifestyle changes like cutting showers short, using a gentle non-soap cleanser, and using a humidifier in dry environments may help you manage this form of eczema.
Can Asteatotic Eczema Be Prevented?
With some consistent self-care, it may be possible to prevent eczema from progressing to the point where the skin fissures. “Preventative treatment of asteatotic eczema includes the application of a topical product that contains ingredients that help to add moisture to the skin or retain moisture in the skin,” says Dr. Turner. “The use of occlusive agents like petrolatum are very helpful for asteatotic eczema. Moisturizers containing ceramides or hyaluronic acid are one of the mainstays of prevention.”
Other agents that work to hydrate the skin and can prevent dry, cracked skin are glycerin, jojoba oil, squalane, and aloe vera. For more product recommendations check out HealthCentral’s Sensitive Skin Awards.
When to Seek Emergency Care
According to Dr. Turner, urgent care should be sought when there are signs of infection. “This can manifest as increasing pain, redness, crusting or oozing of the skin, and fever,” he explains. But when in doubt, always see your doctor when symptoms flare.
The Takeaways
Asteatotic eczema is a type of eczema that may develop as you age, and since it can cause pain and infection when left untreated—and in rare cases may be a sign of malignancy—it’s important to keep an eye out for the symptoms. While keeping skin hydrated will help both prevent and treat the condition, it’s important to see your doctor if you suspect you’re dealing with this subtype for guidance on which combination of treatment strategies may be best for you.
