Asteatotic Eczema and Nonspecific Eczematous Dermatitis in the Elderly

Asteatotic eczema and nonspecific eczematous dermatitis are common forms of dermatitis in the elderly that tend to occur in the dry, cold winter months. These eruptions tend to worsen with aging as the skin loses some of its barrier function and lubrication. Both of these conditions are sometimes referred to as “winter itch” and “senile pruritus.” (See also Chapter 25: Xerosis: The “Dry” Patient.)

Asteatotic Eczema

Scaly patches with superficial fissures that resemble a cracked antique China vase (also called erythema craquelé) (Figs. 13.37 and 13.38).
Often manifest in geometric shapes such as squares, rectangles, and rings (Fig. 13.39).
May be somewhat pruritic.
Lesions are located most commonly on the shins, arms, hands, and trunk.

Nonspecific Eczematous Dermatitis in the Elderly

Ill-defined, dry (xerotic), itchy, scaly, erythematous lesions.
Itching with or without specific lesions tends to occur on the arms, legs, and upper back.

Helpful Hint

Dry skin and persistent pruritus—especially in elderly patients—may be evidence of a systemic condition (e.g., hypothyroidism or hypoparathyroidism), renal disease, or an underlying malignancy.

Management

Asteatotic eczema is managed readily by the use of shorter and/or less frequent showers or baths, using only tepid (not hot) water and the application of moisturizers regularly. Preparations such as Sarna (an anti-itch lotion) or Eucerin Calming Creme, moisturize the skin while soothing the itch.
For both of these conditions, low- to medium-potency (class 4 to 6) topical corticosteroids are valuable. In severe cases, more potent topical corticosteroids (class 1 to 3) may be applied for brief periods when necessary.

Outline
Asteatotic Eczema
Nonspecific Eczematous Dermatitis in the Elderly