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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Asteatotic Eczema" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2023/07/04" /><meta name="citation_author" content="Shane Specht" /><meta name="citation_author" content="Yudy Persaud" /><meta name="citation_pmid" content="31747214" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK549807/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Asteatotic Eczema" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Shane Specht" /><meta name="DC.Contributor" content="Yudy Persaud" /><meta name="DC.Date" content="2023/07/04" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK549807/" /><meta name="description" content="Asteatotic eczema, also known as eczema craquelé, is a common type of pruritic dermatitis. It can also be known as xerosis, which is dry skin. It characterized by dry, cracked, and scaling skin that is typically inflamed. It usually begins as dry skin, and as the disease becomes more severe, the skin can crack and cause fissures. These fissures are a result of epidermal water loss. The fissured skin occurs in a polygonal or curvilinear pattern. The irregular fissuring and scaling patterns are sometimes referred to as &quot;crazing paving.&quot; Patients also report pruritis associated with dry skin.[1]" /><meta name="og:title" content="Asteatotic Eczema" /><meta name="og:type" content="book" /><meta name="og:description" content="Asteatotic eczema, also known as eczema craquelé, is a common type of pruritic dermatitis. It can also be known as xerosis, which is dry skin. It characterized by dry, cracked, and scaling skin that is typically inflamed. It usually begins as dry skin, and as the disease becomes more severe, the skin can crack and cause fissures. These fissures are a result of epidermal water loss. The fissured skin occurs in a polygonal or curvilinear pattern. The irregular fissuring and scaling patterns are sometimes referred to as &quot;crazing paving.&quot; Patients also report pruritis associated with dry skin.[1]" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK549807/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-20893/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK549807/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK549807_"><span class="title" itemprop="name">Asteatotic Eczema</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Shane Specht</span><sup>1</sup>; <span itemprop="author">Yudy Persaud</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> UPMC Pinnacle</div><div class="affiliation"><sup>2</sup> Mt. Sinai</div><p class="small">Last Update: <span itemprop="dateModified">July 4, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-20893.s1"><h2 id="_article-20893_s1_">Continuing Education Activity</h2><p>This activity outlines the evaluation and treatment of asteatotic eczema and reviews the role of the healthcare team in managing patients with this condition. Asteatotic eczema is a dermatological condition that is characterized by dry, fissured skin that occurs from epidermal water loss. It is a common condition that affects mostly geriatric patients in dry, cold climates. Early recognition can lead to treatment and avoid secondary lesions and infections. This activity reviews the evaluation and treatment of asteatotic eczema and highlights the role of the interprofessional team in evaluating and treating patients with this condition.</p><p>
<b>Objectives:</b>
<ul><li class="half_rhythm"><div>Identify the etiology of asteatotic eczema.</div></li><li class="half_rhythm"><div>Review the evaluation of asteatotic eczema.</div></li><li class="half_rhythm"><div>Outline the treatment and management options available for asteatotic eczema.</div></li><li class="half_rhythm"><div>Summarize interprofessional team strategies for improving care coordination and communication to advance asteatotic eczema and improve outcomes.</div></li></ul>
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=20893&#x00026;utm_source=pubmed&#x00026;utm_campaign=reviews&#x00026;utm_content=20893" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Access free multiple choice questions on this topic.</a>
</p></div><div id="article-20893.s2"><h2 id="_article-20893_s2_">Introduction</h2><p>Asteatotic eczema, also known as eczema craquel&#x000e9;, is a common type of pruritic dermatitis. It can also be known as xerosis, which is dry skin. It characterized by dry, cracked, and scaling skin that is typically inflamed. It usually begins as dry skin, and as the disease becomes more severe, the skin can crack and cause fissures. These fissures are a result of epidermal water loss. The fissured skin occurs in a polygonal or curvilinear pattern. The irregular fissuring and scaling patterns are sometimes referred to as "crazing paving." Patients also report pruritis associated with dry skin.<a class="bk_pop" href="#article-20893.r1">[1]</a></p><p>Asteatotic eczema occurs especially in winter months when the skin is more at risk for becoming dry. Asteatotic eczema is also more common in the elderly. The eruption can occur on any skin area but typically presents on the anterolateral aspects of the lower legs. Lesions can also occur on the back, trunk, and arms.</p><p>There have been several case reports of asteatotic eczema correlating with underlying systemic conditions. These included malignancy, hypothyroidism, and malnutrition. Several classes of medications also have demonstrated links to xerosis, including diuretics, retinoids, and antineoplastics agents.<a class="bk_pop" href="#article-20893.r2">[2]</a><a class="bk_pop" href="#article-20893.r3">[3]</a><a class="bk_pop" href="#article-20893.r4">[4]</a><a class="bk_pop" href="#article-20893.r5">[5]</a><a class="bk_pop" href="#article-20893.r6">[6]</a></p></div><div id="article-20893.s3"><h2 id="_article-20893_s3_">Etiology</h2><p>Drying of the skin occurs due to epidermal water loss; this is common in winter months and cold, dry climates. Medications such as diuretics also can exacerbate the drying of the epidermis.<a class="bk_pop" href="#article-20893.r1">[1]</a></p><p>Other factors that contribute to asteatotic eczema include decreased sebaceous and sweat glands in the elderly, friction, frequent prolong bathing in hot water, and the use of degreasing agents.</p><p>Less common causes include radiation, nutritional deficiencies (zinc, essential fatty acids), hypothyroidism, drugs such as diuretics and antiandrogen therapy, and malignancies.<a class="bk_pop" href="#article-20893.r7">[7]</a><a class="bk_pop" href="#article-20893.r8">[8]</a><a class="bk_pop" href="#article-20893.r9">[9]</a><a class="bk_pop" href="#article-20893.r2">[2]</a><a class="bk_pop" href="#article-20893.r10">[10]</a></p></div><div id="article-20893.s4"><h2 id="_article-20893_s4_">Epidemiology</h2><p>Skin conditions affect up to seventy percent of the geriatric population. Among the commonest are those that are caused by or present as dry, itchy skin.<a class="bk_pop" href="#article-20893.r11">[11]</a>&#x000a0;Asteatotic eczema is one of the top three subtypes of dermatitis with severe itching. It closely follows atopic dermatitis and widespread eczema.<a class="bk_pop" href="#article-20893.r12">[12]</a>&#x000a0;Asteotitc eczema is the most common kind of eczema experienced in the elderly.<a class="bk_pop" href="#article-20893.r13">[13]</a></p><p>Asteatotic eczema is most prevalent during winter months. In the United States, the frequency increases in the northern part of the country. This increase in prevalence is believed to be caused by heating, which reduces indoor humidity and contributes to dry skin.&#x000a0;&#x000a0;</p><p>Typically, it is patients over 60 years old who develop asteatotic eczema. The median patient age at presentation is 69 years. However, asteatosis eczema can also occur in young people.</p></div><div id="article-20893.s5"><h2 id="_article-20893_s5_">Pathophysiology</h2><p>People with asteatotic eczema have a decreased amount of free fatty acids in the stratum corneum. Cutaneous loss of these lipids increases transepidermal water loss up to 75 times that of normal patients.<a class="bk_pop" href="#article-20893.r14">[14]</a> The geriatric population has decreased sebaceous and sweat gland activity.<a class="bk_pop" href="#article-20893.r2">[2]</a> This decrease predisposes patients to moisture depletion. To maintain its integrity, the keratin layer requires a significant water concentration, estimated to be 10&#x000a0;to 20%. Excess water loss from the epidermis causes the outer layer of skin, the stratum corneum, to split and fissure.<a class="bk_pop" href="#article-20893.r15">[15]</a>&#x000a0;These fissures can be deep enough to affect dermal capillaries, which can ultimately lead to bleeding. The dryness also causes pruritis, which leads to scratching.&#x000a0; Scratching can produce excoriations, edematous patches, and lichen planus. Allergens and bacteria can also penetrate the skin through these fissures and cause allergic and irritant contact dermatitis or infection.<a class="bk_pop" href="#article-20893.r1">[1]</a></p></div><div id="article-20893.s6"><h2 id="_article-20893_s6_">Histopathology</h2><p>Skin biopsy is not necessary to diagnose asteatotic eczema. However, a microscopic examination will reveal spongiotic dermatitis with intracellular edema that is common among other forms of eczema and dermatitis. There can be varying degrees of inflammatory infiltrate, but most commonly a mild subacute spongiotic dermatitis. Acanthosis, hyperkeratosis, and lymphocytic infiltrate are present. The stratum corneum is&#x000a0;irregular and compact.&#x000a0;</p></div><div id="article-20893.s7"><h2 id="_article-20893_s7_">History and Physical</h2><p>History should consist of the timing of dermatitis, as it is more common in winter months. Pruritis and dry skin are hallmarks of the disease and therefore are common complaints. Ask about other controllable factors, e.g., frequency of bathing, types of soap used, diet, and medications.</p><p>The physical examination will reveal dry and scaly skin. Accentuation of the skin lines (xerosis) is a typical presentation. Red plagues with thin, long, horizontal superficial fissures appear with further drying and scratching. The fissures and scales occur in a curvilinear, polygonal, or curvilinear pattern as the short vertical fissures connect with the horizontal fissures. Fissures are often accompanied by secondary lesions of erythematous and edematous patches that result from rubbing or scratching. Bleeding can occur with disruption of dermal capillaries as the disease progresses or with excoriation. Similar patterns of inflammation may appear on the trunk and upper extremities as the winter progresses.&#x000a0;</p></div><div id="article-20893.s8"><h2 id="_article-20893_s8_">Evaluation</h2><p>The diagnosis of asteatotic eczema is clinical. A skin biopsy can be useful if the clinician is unsure or unable to differentiate from other skin lesions. A skin biopsy will reveal a subacute, eczematous patter with acanthosis. A superficial, perivascular, lymphocytic infiltrate may also occur.</p></div><div id="article-20893.s9"><h2 id="_article-20893_s9_">Treatment / Management</h2><p>Skin hydration is the primary treatment for asteatotic eczema. Patients should use lotions with high oil content. High water lotions can worsen the drying of the skin. Emollients should be applied twice a day and immediately after bathing to maintain hydration.<a class="bk_pop" href="#article-20893.r16">[16]</a></p><p>Topical steroid use should be in conjunction with emollients. Low potency steroids are useful for mild disease. Low potency steroids include desonide and hydrocortisone. Patients with moderate disease should receive medium or high potency corticosteroids. These include fluocinolone, triamcinolone, and betamethasone. Emollients should continue to be used with corticosteroids if corticosteroids are required. It does not affect response whether corticosteroids or emollients are applied first.<a class="bk_pop" href="#article-20893.r16">[16]</a></p><p>Other agents have been shown to be effective as well. Pimecrolimus cream 1% is effective in patients with asteatotic eczema and helps control pruritis.<a class="bk_pop" href="#article-20893.r17">[17]</a>&#x000a0;Topical agents such as alpha-hydroxyl acid moisturizers are also beneficial when applied after warm water soaks or steroid ointment treatment.<a class="bk_pop" href="#article-20893.r18">[18]</a></p><p>Patients can take other steps as well to prevent drying of the skin, including decreasing the frequencies or bathing, minimizing the use of soap, and using a humidifier in dry environments.<a class="bk_pop" href="#article-20893.r1">[1]</a></p><p>N-palmitoylethanolamine (PEA) and N-acetylethanolamine (AEA) are phospholipids that belong to the endocannabinoid system. One study showed that emollients containing PEA and AEA improved skin barrier function and reduced itching; this is a possible future treatment option; however, more studies are necessary.<a class="bk_pop" href="#article-20893.r19">[19]</a></p></div><div id="article-20893.s10"><h2 id="_article-20893_s10_">Differential Diagnosis</h2><p>Differential diagnosis included acute edema/cutaneous distension syndrome, myxedema, cellulitis, stasis dermatitis, allergic contact dermatitis, irritant contact dermatitis, and nummular dermatitis.<a class="bk_pop" href="#article-20893.r20">[20]</a><a class="bk_pop" href="#article-20893.r21">[21]</a><a class="bk_pop" href="#article-20893.r6">[6]</a></p></div><div id="article-20893.s11"><h2 id="_article-20893_s11_">Prognosis</h2><p>Asteatotic eczema responds well to therapy but can relapse during winter months or without the removal of offending agents.&#x000a0;</p></div><div id="article-20893.s12"><h2 id="_article-20893_s12_">Complications</h2><p>The most severe form of asteatotic eczema has deep, wide, horizontal fissures that ooze and are often purulent. Pain rather than itching is often the chief complaint in more severe cases. Infection with an accumulation of crusts and purulent material can be present with scratching or using drying lotions.</p></div><div id="article-20893.s13"><h2 id="_article-20893_s13_">Deterrence and Patient Education</h2><p>Patients who present with asteatotic eczema should be comforted that it is likely a benign condition, although underlying malignancies have correlations with the disease. The importance of emollients is a point of emphasis for the patients. Patients also need to be educated on the risk of scratching. Scratching causes a break in the skin, which can lead to infection. Patients also need to understand that asteatotic eczema is likely to recur in the winter months.&#x000a0;</p></div><div id="article-20893.s14"><h2 id="_article-20893_s14_">Enhancing Healthcare Team Outcomes </h2><p>The majority of patients with asteatotic eczema first present to the primary care clinicians, including nurses, which is why an interprofessional team approach is the best means by which to address the condition. There is low awareness of this skin condition among nurses and pharmacists, which leads to undertreatment, causing a reduction in the well-being of the patients. This phenomenon is particularly noticed in the setting of long term care nursing facilities. For an accurate and efficient technique to detect asteatotic eczema, education should be provided, including a simple visual assessment method for dry skin. Clinicians and nurses should be in constant communication about the resident's/patient's rashes and skin lesions.<a class="bk_pop" href="#article-20893.r22">[22]</a></p><p>It is crucial to educate the patient on the importance of hydration and apply oil-based moisturizers. The pharmacist should assess the medications and ensure that none is worsening the condition. If there are any questions regarding the treatment, a dermatologist consult is necessary. Close communication between interprofessional team members can help improve not only the patient's quality of life but improve outcomes. [Level 5]</p></div><div id="article-20893.s15"><h2 id="_article-20893_s15_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div class="floats-group" id="article-20893.s16"></div><div id="article-20893.s17"><h2 id="_article-20893_s17_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-20893.r1">Norman RA. Xerosis and pruritus in the elderly: recognition and management. <span><span class="ref-journal">Dermatol Ther. </span>2003;<span class="ref-vol">16</span>(3):254-9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14510882" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 14510882</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-20893.r2">Sparsa A, Liozon E, Boulinguez S, Bordessoule D, Vidal E, Bonnetblanc JM, Bedane C. 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Eczema craquel&#x000e9; associated with antiviral treatment for chronic hepatitis C. <span><span class="ref-journal">An Bras Dermatol. </span>2017 May-Jun;<span class="ref-vol">92</span>(3):436-437.</span> [<a href="/pmc/articles/PMC5514600/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC5514600</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29186272" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 29186272</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-20893.r5">Yang CS, Lott JP, Bunick CG, Bolognia JL. Eczema craquel&#x000e9; associated with nephrotic syndrome. <span><span class="ref-journal">JAAD Case Rep. </span>2016 May;<span class="ref-vol">2</span>(3):241-3.</span> [<a href="/pmc/articles/PMC4927654/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC4927654</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27408932" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 27408932</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-20893.r6">Patrizi A, Gurioli C, Tengattini V, Bardazzi F. Eczema craquel&#x000e9;, an uncommon clinical manifestation of myxedema. <span><span class="ref-journal">J Dtsch Dermatol Ges. </span>2015 May;<span class="ref-vol">13</span>(5):453-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25918092" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 25918092</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-20893.r7">Weismann K, Wadskov S, Mikkelsen HI, Knudsen L, Christensen KC, Storgaard L. Acquired zinc deficiency dermatosis in man. <span><span class="ref-journal">Arch Dermatol. </span>1978 Oct;<span class="ref-vol">114</span>(10):1509-11.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/718188" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 718188</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-20893.r8">Warin AP. Ecz&#x000e9;ma craquel&#x000e9; as the presenting feature of myxoedema. <span><span class="ref-journal">Br J Dermatol. </span>1973 Sep;<span class="ref-vol">89</span>(3):289-91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4743432" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 4743432</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-20893.r9">Greist MC, Epinette WW. Cimetidine-induced xerosis and asteatotic dermatitis. <span><span class="ref-journal">Arch Dermatol. </span>1982 Apr;<span class="ref-vol">118</span>(4):253-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6461297" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 6461297</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-20893.r10">Barker DJ, Cotterill JA. Generalized ecz&#x000e9;ma craquel&#x000e9; as a presenting feature of lymphoma. <span><span class="ref-journal">Br J Dermatol. </span>1977 Sep;<span class="ref-vol">97</span>(3):323-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/921903" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 921903</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-20893.r11">Ward S. Eczema and dry skin in older people: identification and management. <span><span class="ref-journal">Br J Community Nurs. </span>2005 Oct;<span class="ref-vol">10</span>(10):453-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16234740" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16234740</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-20893.r12">Wang X, Li L, Shi X, Zhou P, Shen Y. Itching and its related factors in subtypes of eczema: a cross-sectional multicenter study in tertiary hospitals of China. <span><span class="ref-journal">Sci Rep. </span>2018 Jul 17;<span class="ref-vol">8</span>(1):10754.</span> [<a href="/pmc/articles/PMC6050257/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC6050257</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30018382" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 30018382</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-20893.r13">Polat M, &#x00130;lhan MN. Dermatological Complaints of the Elderly Attending a Dermatology Outpatient Clinic in Turkey: A Prospective Study over a One-year Period. <span><span class="ref-journal">Acta Dermatovenerol Croat. </span>2015;<span class="ref-vol">23</span>(4):277-81.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26724880" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 26724880</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-20893.r14">Akimoto K, Yoshikawa N, Higaki Y, Kawashima M, Imokawa G. Quantitative analysis of stratum corneum lipids in xerosis and asteatotic eczema. <span><span class="ref-journal">J Dermatol. </span>1993 Jan;<span class="ref-vol">20</span>(1):1-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8482746" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 8482746</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-20893.r15">Cassler NM, Burris AM, Nguyen JC. Asteatotic eczema in hypoesthetic skin: a case series. <span><span class="ref-journal">JAMA Dermatol. </span>2014 Oct;<span class="ref-vol">150</span>(10):1088-90.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25029204" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 25029204</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-20893.r16">Ng SY, Begum S, Chong SY. Does Order of Application of Emollient and Topical Corticosteroids Make a Difference in the Severity of Atopic Eczema in Children? <span><span class="ref-journal">Pediatr Dermatol. </span>2016 Mar-Apr;<span class="ref-vol">33</span>(2):160-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26856694" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 26856694</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-20893.r17">Schulz P, Bunselmeyer B, Br&#x000e4;utigam M, Luger TA. Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients. <span><span class="ref-journal">J Eur Acad Dermatol Venereol. </span>2007 Jan;<span class="ref-vol">21</span>(1):90-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17207174" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17207174</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-20893.r18">Miller DW, Koch SB, Yentzer BA, Clark AR, O'Neill JR, Fountain J, Weber TM, Fleischer AB. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. <span><span class="ref-journal">J Drugs Dermatol. </span>2011 May;<span class="ref-vol">10</span>(5):531-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21533301" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 21533301</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="article-20893.r19">Yuan C, Wang XM, Guichard A, Tan YM, Qian CY, Yang LJ, Humbert P. N-palmitoylethanolamine and N-acetylethanolamine are effective in asteatotic eczema: results of a randomized, double-blind, controlled study in 60 patients. <span><span class="ref-journal">Clin Interv Aging. </span>2014;<span class="ref-vol">9</span>:1163-9.</span> [<a href="/pmc/articles/PMC4111646/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC4111646</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25071367" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 25071367</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="article-20893.r20">Yamada S, Sawada Y, Ohmori S, Omoto D, Haruyama S, Kubo R, Yoshioka M, Nishio D, Nakamura M. Acute edema/cutaneous distension syndrome representing as ecz&#x000e9;ma craquel&#x000e9;-like change: A case and published work review. <span><span class="ref-journal">J Dermatol. </span>2016 Jun;<span class="ref-vol">43</span>(6):709-10.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26775716" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 26775716</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="article-20893.r21">Bhushan M, Cox NH, Chalmers RJ. Ecz&#x000e9;ma craquel&#x000e9; resulting from acute oedema: a report of seven cases. <span><span class="ref-journal">Br J Dermatol. </span>2001 Aug;<span class="ref-vol">145</span>(2):355-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11531813" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 11531813</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="article-20893.r22">Kimura N, Nakagami G, Takehara K, Miura Y, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Prevalence of asteatosis and asteatotic eczema among elderly residents in facilities covered by long-term care insurance. <span><span class="ref-journal">J Dermatol. </span>2013 Sep;<span class="ref-vol">40</span>(9):770-1.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23855654" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 23855654</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
<b>Disclosure: </b>Shane Specht declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
<b>Disclosure: </b>Yudy Persaud declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div><div class="bk_prnt_sctn"><h2>Figures</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="article-20893.image.f1" class="figure bk_fig"><div class="graphic"><img src="/books/NBK549807/bin/eczema__craquele.jpg" alt="Image eczema__craquele" /></div><div class="caption"><p>Eczema, Craquele <a href="https://dermnetnz.org/images" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">DermNet New Zealand</a></p></div></div></div></div></div></div>
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