Eczema craquelé

What is eczema craquelé?

Eczema craquelé is a common type of dermatitis that occurs as a result of very dry skin. It got its French name from its cracked appearance. It is also known as asteatotic eczema (lack of oil) or xerotic (dry) eczema.

The most common site is the shins, but eczema craquelé may occur elsewhere including upper limbs and trunk. Mild eczema craquelé may be unnoticed but it may become extremely itchy. Scratching tends to make it worse.

What does it look like?

Eczema craquelé has a distinctive crazy-paving appearance. Diamond-shaped plates of skin are separated from each other by red bands. There may also be scratch marks. It may start on one shin but soon spreads to affect the skin around both lower legs.

Severe eczema craqelé can lead to more severe secondary dermatitis with generalised redness, localised swelling and surface blistering. Like other forms of eczema on the lower leg, it can eventually result in autoeczematisation (skin autosensitisation) with an itchy rash appearing on the forearms then elsewhere on the body.

Eczema craquelé

Who gets eczema craquelé?

Eczema craquelé can occur in anyone with very dry skin although it is much more common in elderly people and during the winter months. Typical causes include:

• Lifelong dry skin due to various forms of ichthyosis
• Underlying atopic dermatitis/eczema
• Dry climate e.g. in a desert or at high altitude
• Dry indoor environment e.g. aeroplane travel, use of dehumidifier or air conditioning
• Excessive bathing
• Overuse of soaps and astringents
• Exposure to heat source that dries the skin, e.g. fan heater or wood fire
• Thyroid deficiency (hypothyroidism)
• Malnutrition, particularly malabsorption of zinc and essential fatty acids
• Drugs, particularly diuretics and acitretin
• Debility due to underlying weight loss especially cachexia associated with serious diseases such as advanced cancer.

What causes eczema craquelé?

Dry skin lacks an effective skin barrier.

• It doesn't hold as much water within the horny, dead cells on the skin surface.
• Minor irritants such as soaps or woollen socks set up an inflammatory reaction.

What tests should be done?

Eczema craquelé is diagnosed by its appearance and no tests are necessary in the majority of patients.

Thyroid function tests are appropriate if there are other signs to suggest hypothyroidism, such as dry thinning hair, weight gain, lethargy and slowness. If eczema craquelé is of recent onset and accompanied by excessive scaling (acquired ichthyosis), weight loss, fevers or general unwellness (malaise), the patient should be thoroughly investigated for an internal cause.

What is the treatment for eczema craquelé?

Eczema craquelé usually rapidly responds to treatment.

• Consider factors that have caused dry skin: bathe less frequently, use a cream cleanser instead of soap, do not expose skin to direct heat.
• Apply thick emollients and moisturisers such as petroleum jelly / petrolatum or oily cream several times daily – after a few days thinner ones such as non-ionic cream should be adequate.
• Apply mild topical steroid cream or ointment to reddened skin for a few days; hydrocortisone cream or ointment is often sufficient.
• A more potent topical steroid may be necessary if the eczema is severe.

Ensure the skin is not allowed to dry out again, as eczema craquelé is very likely to recur.