Asteatotic Eczema — SCE Dermatology MCQ

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EasyInflammatory DermatosesAsteatotic EczemaSCE Dermatology

A 68-year-old woman with asteatotic eczema on her lower legs presents with dry cracked skin in a 'crazy paving' pattern. It worsens in winter with central heating. What is the most appropriate first-line management?

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Correct answer: B — Regular emollient application with soap substitute and humectant-containing moisturiser

Asteatotic eczema (eczema craquelé) results from reduced sebum production and skin barrier dysfunction, exacerbated by low humidity (central heating), excessive washing, and diuretics. The 'crazy paving' pattern of fine fissures is characteristic. First-line management is intensive emollient therapy using greasy ointment-based emollients and humectant-containing moisturisers (urea, glycerol) with soap substitutes. Moderate topical corticosteroids may be added for inflammatory flares but are not first-line. Addressing environmental factors (avoiding overwashing, using humidifiers) is important.

Reference: NICE 2007 CG57 (updated 2023); BAD Emollient Guidelines