Elderly Skin Conditions series – Asteatotic Eczema (Xerosis or Cracked Skin Eczema)

This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

So far we have covered stasis dermatitis (at the lower extremity), incontinence associated dermatitis (at the genital area up to upper thigh) and for the last part of this series, we will explore asteatotic eczema, another common elderly skin condition affecting the lower leg.

What is Asteatotic Eczema?

Also known as xerosis (abnormal dryness), cracked skin eczema or eczema craquele, it is a scaly, flaky, cracked skin condition due to dry skin. The symptoms are scales, cracks, fissures, redness, dryness and itch. If the skin is cracked deeply to injure the capillaries, bleeding fissures may be seen. These symptoms usually present at the lower leg but may also affect the arms, thighs, hands and lower back.

Asteatotic eczema is most prevalent in elderly, above age 65.

What Causes Asteatotic Eczema?

As discussed in the very first post of this series, elderly skin has weaker ability to retain moisture, thus more likely to have dry skin. Less oil and sweat glands also contribute to skin dryness. Their skin is also thinner. The dryness is worsened during winter or cold air-conditioning where the humidity is low (below 50). Other possible factors that contribute to dry skin are long, hot showers, rubbing to towel dry (instead of dab dry), harsh soaps and lack of moisturizing. Dehydration and malnutrition may also play a role, for instance not drinking enough fluids and lacking essential fatty acids and zinc.

Other causes include underactive thyroid, severe weight loss and lymphoma. Medications such as retinoids, diuretics and protein kinase inhibitors may also cause asteatotic eczema.

Complications of Asteatotic Eczema

As with all dry, itchy skin conditions that lead to chronic scratching, infection can occur. Lesions may form and overtime rubbing causes skin discoloration. Also possible are thickened skin (lichenification) or red patches of skin. With damaged skin barrier, the potential for allergic and irritant contact dermatitis increase.

Prevention of Asteatotic Eczema

Good Skincare Routine – Refer to these videos on skincare (shower, moisturizing), with the few basics below:

1. Avoid harsh soap and products with top irritants, like fragrance
2. Lukewarm shower, keep it short and for elderly who do not sweat much/head outdoors, daily shower is sufficient (or wet wipe the body on few days/week)
3. Moisturize after shower
4. Have humidifier if bedroom’s humidity is below 50.
5. Dab dry and not rub dry after shower
6. Do not use products that increase friction to skin, e.g. exfoliating bits found in facial wash or wool/scratching material
7. Frequent change of towel, and use softer material towels

Treatment of asteatotic eczema may include a combination of keratolytics (able to soften, loosen and facilitate exfoliation of upper skin cells), moisturizers and topical steroids (again, use with care given the already thin skin of elderly and higher potential for irritant dermatitis from chemicals in creams).

While looking up asteatotic eczema, I realized that there isn’t much written on it including research in Pubmed. I wonder if it’s because it seems not as serious as other skin conditions, or that research is often more focused on children and adults (or difficulty to conduct studies). In any case, we should not forget the skin health of our elderly family members and that’s what this entire past 4 weeks have been about! Share and support each other in our elderly skincare!