Eczema Asteatótico | Craquelê | em leito de rio seco

AKA eczema craquelê, em leito de rio seco
 
Etiologia
  • Endógenos
    • Marasmus or malnutrition
    • Chronic kidney disease and hemodialysis
    • Hypothyroidism
    • HIV infection
    • Aging
    • Ictiose vulgar
    • Dermatite atópica
    • Malignidade → o eczema craquelê pode ser uma síndrome paraneoplásica
  • Exógenas
    • Dry climate
    • Low indoor humidity
    • Excessive exposure to water, soaps, surfactants
 
Pathogenesis
  • Xerosis
  • Decreased intercelular lipids in stratum corneum
  • Pode ter Dermatite de contacto irritativa concomitante
 
Epidemiologia
  • Inverno
  • Indivíduos idosos que tomam banho e não aplicam creme hidratante
 
Clinical presentation
  • Xerotic skin is dry and dull, with fine bran like scales that may be released as powdery clouds when patients take off their stockings
  • Criss cross pattern of superficial cracks and fissures of the horny layer (”crazy-paving”, eczema craquelé; “dried riverbed”, “pseudo-ichthyosis”)
  • May have dull erythema, oozing, crusting, abundant excoriations
  • Vesiculation and lichenification not regular features unless contact dermatitis superimposed
  • Initially on the shins
 
DDx
  • Stasis dermatitis
  • Adult atopic dermatitis
  • Allergic contact dermatitis
  • Scabies
 
Tratamento
  • Emolientes
    • Vaselina
    • Water in oil emollients
    • Urea, ceramid, lactic acid containing
  • Bath oils
  • Aumentar humidade do ambiente se possível
  • Eliminate factors that aggravate dry skin
  • Evitar lã, preferir algodão
  • Tratar eventual dermatite de estase coexistente
  • Corticoides tópicos
  • Topical calcineurin inhibitors