Asteatotic dermatitis L30.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 14.05.2021

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Synonym(s)

Asteatosis cutis; asteatotic eczema; dehydrated skin; Dehydration eczema; dermatitis asteatotica; Desiccation; desiccation dermatitis; Desiccation dermatitis; Desiccation eczema; Desiccation eczematide; eczema craquelé; Skin dryness; Winter eczema; Winter itch; Xerose; Xerosis; Xerotic eczema

History
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Brocq, 1907

Definition
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Chronic dermatitis on the bottom of an extremely dry skin in sebostasis, especially in elderly patients, in case of wrong, exaggerated personal hygiene or as side effects of medication (see below drug reaction, undesired).

Occurrence/Epidemiology
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No gender bias; the predisposition to "dry skin" is inherited and generally remains asymptomatic or does not require treatment in the first decades of life. In the second half of life, a need for therapy increasingly arises in those with the corresponding disposition. Here, an increasing age-induced skin dryness meets a washing ritual which has been "trained" since early youth with whole body soaping and use of liquid soaps or -syndets.

Long-lasting and hot baths intensify the drying effect on the skin.

Affected by an increased, trickling otherwise little symptomatic scaling, are here first lower legs and forearms, later also the body trunk.

The increasing dehydration of the integument then becomes symptomatic with an unpleasant feeling of tension "one no longer feels comfortable in one's skin".

Etiopathogenesis
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Dehydration or destruction of the natural skin protection e.g. after excessive use of soaps or shower products in daily body care. More rarely caused by malnutrition, vulgar ichthyosis, anorexia nervosa, neurological underlying diseases (e.g. in alcohol abuse) or after systemic drug therapies (e.g. isotretinoin, indinavir, bevacizumab). The findings of exsiccation dermatitis may also manifest in hypaesthetic skin (regardless of the age of the affected person) (Cassler NM et al. 2014).

Manifestation
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Mostly occurring in older men after the 60th LJ. Also occurs in younger people, e.g. due to the intake of drugs exsiccating the skin such as isotretinoin or due to the permanent use of diuretics. Furthermore, atopic patients or patients with ichthyosis suffer from dry skin, which can also lead to a dehydration of the integument if no therapeutic measures are taken. The signs of desiccation usually worsen in winter or become manifest during this season.

Localization
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Lower legs (especially pretibial), extensor sides of the arms, trunk.

Clinical features
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Dry, large-area, differently itching, occasionally painful, sometimes fine-lamellar, sometimes coarse-lamellar scaling, in places also reddened areas with superficial, net-like patterned tears or fissures. Often scratch excoriations or superficial bleeding. Occasional dysesthesias. The appearance of the skin is reminiscent of a dried-out river bed with deep cracks or cracked porcelain and is more pronounced during the winter months than in the warm season. As the disease progresses, coin-shaped, reddish-brownish, scaly, infiltrated plaques develop.

Differential diagnosis
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The exiccation eczema of:

General therapy
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Patient education: change of showering and bathing habits, keeping the humidity constant, avoiding woollen clothing, sufficient fluid intake.

External therapy
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Regrease the skin with externals such as base cream (DAC), Eucerin cum aq., ash base cream, Linola milk. Extremely sparing use of cleansing agents like syndets or soaps. Instead, mild cleansing of the body skin with hydrophilic body oils. This achieves a sufficient cleansing effect while at the same time providing a regreasing body care. Instead of hydrophilic oils also O/W emulsions can be used, e.g. base lotion or commercial emulsions like Abitima body lotion, Excipial U Hydrolotio, Sebamed lotion. Briefly shower off the skin, apply and spread the emulsion on the moist skin, briefly shower off again, the remaining emulsion film is not perceived as unpleasant. Oil baths such as the"Cleopatra Bath", Cordes Oil Bath, Linola Fat N Oil Bath, Balneum Hermal Oil Bath also have a soothing and refatting effect on the skin.)

Helpful and well tolerated are usually also 2-10% urea preparations (Excipial U Lipolotio, Basodexan Softcreme/Fettcreme, Linola Urea Creme, Nubral Creme or as a formulation: urea-cetomacrogolsalbe 10% or urea 5% in Unguentum emulsificans aquosum). Alternatively: ointments containing dexpanthenol e.g. R065).

In severe cases and in case of persistent itching, apply weakly to moderately potent glucocorticoid-containing topical preparations for a short time (e.g. Laticort® cream/ointment, Linola® H fat, Advantan® ointment/ointment, Dermatop® ointment/ointment).

Internal therapy
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Antihistamines like desloratadine (e.g. Aerius 1-2 tbl/day) or levocetirizine (e.g. Xusal 1-2 filmtbl/day).

Note(s)
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The congenital skin dehydration has to be distinguished from analogous desiccation pictures, the pseudoichthyoses or also ichthyosis acquisita, which occur in final tumor diseases, in frail elderly people, in people on dialysis, in HIV-infected people as well as after taking certain drugs (lipid-lowering agents, psychotropic drugs, cimetidine, clofazimine; isotretinoin, indinavir, bevacizumab).

Literature
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  1. Akimoto K et al (1993) Quantitative analysis of stratum corneum lipids in xerosis and asteatotic eczema. J Dermatol 20: 1-6
  2. Bhushan M et al (2001) Eczema craquele resulting from acute oedema: a report of seven cases. Br J Dermatol 145: 355-357
  3. Brocq LAJ (1907) Traité élémentaire de dermatologie pratique comprenant les syphilides cutanées. Octave Douin (Paris)
  4. Calista D, Boschini A (2000) Cutaneous side effects induced by indinavir. Eur J Dermatol 10: 292-296.
  5. Cassler NM et al (2014) Asteatotic eczema in hypoesthetic skin: a case series. JAMA Dermatol 150(10):1088-1090.

  6. Ishiguro N et al (2001) Linear erythema craquele due to acute oedema in anorexia nervosa. Br J Dermatol 145: 357-359.

  7. Norman RA (2003) Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther 16: 254-259
  8. Specht S et al (2021) Asteatotic Eczema. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; PMID: 31747214.
  9. Yu RJ et al. (2001) Objective bioengineering methods to assess the effects of moisturizers on xerotic leg skin of elderly people. Dermatolog Treat 12: 181

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 14.05.2021