Asteatotic eczema, also known as xerotic eczema, dryness eczema or asteatotic dermatitis, is a specific type of eczema that occurs mainly in older adults, especially during cold months or in dry climates. It is characterized by extremely dry skin that may crack, flake, and become inflamed, causing intense itching and discomfort.
Although it is not contagious or life-threatening, asteatotic eczema can significantly affect quality of life, especially when not properly treated. The good news is that with simple and consistent care, it is possible to control symptoms and avoid flare-ups.
What causes asteatotic eczema?
The main cause of asteatotic eczema is the loss of lipids and moisture from the outer skin layer, which compromises its barrier function. When the skin is dry, it becomes more vulnerable to irritation, inflammation, and penetration by external agents.
Factors that contribute to this dryness include:
Hot and prolonged showers
Excessive use of soap or harsh products
Prolonged exposure to dry environments with air conditioning or heating
Advanced age (aging skin produces fewer natural lipids)
Systemic diseases such as hypothyroidism, malnutrition, and kidney failure
Use of certain medications, such as diuretics
Repeated friction or wearing rough clothing
What are the symptoms?
Symptoms of asteatotic eczema mainly appear on the legs but may also affect the arms, torso, and back. The most common signs include:
Severe skin dryness
Flaking with a “paving” or “cracked” appearance
Intense itching
Redness and inflammation
Painful cracks
Burning or stinging sensation
Itching often worsens at night, which may interfere with sleep. Moreover, scratching may cause small skin lesions, allowing bacteria to enter and leading to secondary infections.
Who is at greater risk?
Asteatotic eczema is more common in:
Elderly individuals
People living in cold or dry climates
Individuals with a history of atopic eczema or other dermatitis
Patients with chronic diseases that impair skin function
People with poor hydration habits or harsh hygiene
Diagnosis
Diagnosis is clinical, made by a dermatologist, based on visible skin signs and the patient’s medical history. Laboratory tests are usually not necessary, but in doubtful cases, the doctor may order tests to rule out other causes of dermatitis or to investigate underlying diseases.
Treatment of asteatotic eczema
Treatment is based on restoring the skin barrier and reducing inflammation. Main strategies include:
1. Intense and frequent moisturization
The cornerstone of treatment is daily use of strong moisturizers, preferably:
Fragrance-free and dye-free
Containing urea, glycerin, ceramides, or lactic acid
Applied right after bathing, while the skin is still damp
In more severe cases, the dermatologist may recommend thicker, more occlusive ointments, such as pure petroleum jelly or lanolin-based creams.
2. Hygiene modifications
Reduce bath time (5 to 10 minutes)
Use lukewarm instead of hot water
Avoid loofahs and regular soaps (use syndet soaps or bath oils)
Pat dry with a soft towel, do not rub
3. Topical medications
Topical corticosteroids may be used for a short period during severe inflammation.
In case of secondary infection, the doctor may prescribe topical or oral antibiotics.
4. Environmental and lifestyle adjustments
Use of humidifiers in dry environments
Avoid rough or synthetic fabrics
Drink plenty of water
Monitor any associated systemic diseases
Myths and facts about asteatotic eczema
“Just applying a regular moisturizer will fix it.”
Not always. Regular moisturizers may contain fragrances and alcohol that further irritate the skin. Ideally, use products intended for extremely dry or eczema-prone skin.
“This type of eczema is contagious.”
False. Asteatotic eczema is not caused by viruses or bacteria, so it is not spread through contact.
“Once it appears, it never goes away.”
Partially true. It is a chronic and recurrent condition, especially in cold or dry months. However, with ongoing care, it can be controlled and flare-ups prevented.
Prognosis and prevention
With proper treatment and simple routine changes, asteatotic eczema usually responds well and does not leave permanent damage. Prevention is essential, especially in predisposed individuals. Key preventive measures include:
Moisturize the skin daily, even without symptoms
Avoid long, hot showers
Use gentle or dry-skin-specific soaps
Protect yourself from very dry environments (use humidifiers)
Consult a dermatologist regularly, especially for older adults
