Asteatotic Eczema Research Articles

Assessment of the Vehicle for Roflumilast Cream Compared to a Ceramide-Containing Moisturizing Cream in Mild Eczema.

Inflammatory dermatologic conditions suitable for topical treatments benefit from a hydrating vehicle that improves the skin barrier without irritation. This research was designed to assess skin barrier effects and aesthetic attributes of the vehicle for topical roflumilast cream (vehicle) vs a currently marketed ceramide-containing moisturizing cream (moisturizer). This was a single-site, randomized, intraindividual, double-blind, controlled study conducted over 17 days. Patients (aged 18 years or older) with mild, symmetric asteatotic eczema of the lower extremities were enrolled to receive lower leg applications of the vehicle on one leg and moisturizer on the other. The primary efficacy endpoint was a change in transepidermal water loss (TEWL) from baseline to day 15. Secondary efficacy endpoints included change from baseline in TEWL at other study visits, change from baseline in hydration as assessed via corneometry, and patient- and investigator-rated assessments of the products. Safety and tolerability were also assessed. A total of 40 patients enrolled in the study. The primary efficacy endpoint was met for both treatments. A statistically significant difference in TEWL on day 1 favored the moisturizer, but no difference was seen between vehicle and moisturizer at any other timepoint. Both vehicle and moisturizer also met the secondary efficacy endpoint of change from baseline in hydration. The sample size was small. The vehicle for roflumilast cream performed similarly to a leading, currently marketed, dermatologist-recommended, ceramide-containing moisturizer across all patient- and investigator-rated assessments of efficacy, tolerability, and aesthetic properties in patients with mild asteatotic eczema. J Drugs Dermatol. 2024;23(10):834-840. doi:10.36849/JDD.7958 &nbsp.

Asteatotic eczema, a cutaneous manifestation of Hodgkin lymphoma in older patients.

Asteatotic eczema, a cutaneous manifestation of Hodgkin lymphoma in older patients.

What you need to know about common skin problems in older adults.

Skin ageing is a multifaceted process impacted by both intrinsic and extrinsic factors. Drier and less elastic skin with declining sebum levels in older age makes ageing skin more vulnerable to various skin conditions, including infections, inflammatory dermatoses, and cancers. Skin problems are common among older adults due to the effects of ageing, polypharmacy and multimorbidity impacting not only physical health but wellbeing and quality of life. In the UK, older adults in geriatric medicine wards may present with various skin conditions. Hospitalised older individuals may have undiagnosed skin problems unrelated to their admission, making hospitalisation an opportunity to manage unmet needs. Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders clinicians encounter in the geriatric medicine wards. This article outlines the importance of performing comprehensive skin assessments to help diagnose and commence management for these common conditions.

Retrospective Evaluation of Misdiagnosed Scabies Cases: Clinical and Epidemiological Features and Resemblance to Other Dermatological Conditions

Background and Aim: Diagnosing scabies, a skin condition caused by mites, can be challenging due to its resemblance to other skin problems. Avoiding misdiagnoses could result in a significant reduction in treatment delays and complications. Our objective was to investigate scabies cases that initially posed diagnostic challenges.
 Methods: This retrospective study focused on scabies patients who were initially misdiagnosed despite routine clinical examinations and underwent histopathological examinations with different preliminary dermatological diagnoses. Inclusion criteria were in accordance with the 2020 International Alliance for the Control of Scabies Diagnosis Criteria. The study retrospectively compiled clinical, histopathological, and demographic characteristics, providing data on the challenges and delays in diagnosing scabies cases that mimic other dermatological conditions.
 Results: In a cohort of 27 scabies cases with diagnostic challenges, the majority were females (63%) with a mean age of 64.8±15.9 years. Pre-admission, 66.7% of the patients used systemic antihistamines, 52.4% used immunosuppressants, and 42.9% used topical scabies treatment. Secondary xerosis cutis and contact dermatitis were noted in 11.1% and 7.4% of cases. The most frequently considered differential diagnoses by dermatologists included prurigo subacuta (29.6%), dermatitis herpetiformis (18.5 %), lymphomatoid papulosis (14.8%), and vesicular/bullous pemphigoid (11.1 %).
 Conclusion: Previous treatments; prolonged infestations leading to severe secondary dermatological problems including prurigo subacuta, contact dermatitis, and xerotic eczema; atypical distribution of lesions; female prurigo; and elderly with prolonged pruritic atypical dermatoses or vesicular/bullous presentations should be kept in mind as clinical scenarios that may contribute to a delay in the diagnosis of scabies.

Eczema and its treatment in older adults

Eczema encompass awide range of dermatoses that can affect elderly patients in particular. Common differential diagnoses in elderly patients include asteatotic eczema, late-onset atopic dermatitis, allergic contact dermatitis, early phases of mycosis fungoides, eczematous and pruriginous variants of premonitory bullous pemphigoid, as well as eczematized scabies and post-scabietic eczema. Given the partly overlapping clinical presentations, accurate diagnosis plays acrucial role in the management of these conditions. Therapeutic options depend on the underlying disease and necessitate an individualized approach. This review presents relevant types of eczema in older adults together with diagnostic and therapeutic approaches. In addition to confirming the diagnosis and selecting the appropriate treatment, aspects relevant to the care of older patients should be incorporated into the tailored therapeutic approach.

A clinicoepidemiological study of geriatric dermatoses

Skin diseases are a common and inevitable consequence of ageing. Moreover, the clinical presentation is not as classical as they do in the younger population. A lifetime of solar exposure, along with intrinsic changes in the dermal structures, predisposes to a variety of skin diseases.
 The aim: to study the spectrum of various geriatric dermatoses among our patient population at the Department of Dermatology, Venereology, and Leprosy at Kamineni Academy of Medical Sciences and Research Centre.
 Materials and methods: in this study, a total of 200 patients aged 60 years and above attending the DVL OPD of Kamineni Academy of Medical Sciences and Research Centre were included.
 Results: maximum number of patients in this study belonged to 60-65 years (60 %), Male to female ratio was 1.86:1. Most of the males had agriculture work, and most of the females were housewives. Diabetes mellitus was the commonest associated systemic disease seen in 68 cases (34 %), and generalised pruritus was the commonest symptom seen in 64 (32 %) cases, of which 42 cases (65.6 %) were associated with xerosis. Pathological skin disorders and eczematous conditions were seen in 56 out of 200 cases. Of this, asteatotic eczema was the common finding among the eczematous conditions seen in 14 cases (7 %). Psoriasis was seen in 32 (16 %) and lichen planus in 10 cases (5 %). Infectious diseases were seen in 78 cases (39 %). Of these, fungal infections were common, seen in 28 cases (14 %). The benign tumour was seborrheic keratosis in this study, seen in 61 cases (30.5 %); among the malignant tumours, 4 cases (2 %) of basal cell carcinoma and 2 cases (1 %) of squamous cell carcinoma were seen. Among 16 cases of bullous disorders, bullous pemphigoid was seen in 12 (6 %) cases. Among 22 cases of psychocutaneous disorders, delusional parasitosis was seen in 10 cases (5 %), and perforating folliculitis in 15 cases (7.5 %). Loss of luster was the commonest nail change seen in 182 cases (91 %), followed by nail plate thickening in 54 cases (27 %). Greying of the hair was seen in all cases. Out of 70 females, diffuse hair loss was seen in 58 cases (82.9 %), and out of 130 males, androgenetic alopecia was seen in 72 cases (55.4 %).
 Conclusion: skin diseases cause considerable morbidity in the elderly, particularly if associated with other comorbid conditions. Health education on proper skin care, avoidance of irritants and self-medication etc., would help to reduce the incidence of common dermatoses.

Evaluation of Clinical Knowledge Regarding Geriatric Skin Conditions among Thai Physicians

Objective: Assess the knowledge of common geriatric skin conditions in Thai physicians.Materials and Methods: This retrospective study was conducted among Thai physicians attending annual dermatology courses by the Dermatological Society of Thailand from 2016 to 2019. Data was assessed based on knowledge of diagnosis and management of common geriatric skin conditions.Results: A total of 197 participants, mainly general practitioners, were included. The highest percentage of correct diagnoses were benign erythematous, eczematous lesions (35.5%, senile purpura; 36.0%, xerotic eczema), and malignant diseases (35.5%, basal cell carcinoma; 27.4%, squamous cell carcinoma; 11.7%, subungual melanoma; 24.4%, acral lentiginous melanoma). In contrasts, the lowest percentage of correct diagnosis were premalignant diseases (0.5%, arsenical keratosis; 4.6%, actinic keratosis; 1.0% Bowen’s disease) and benign hypopigmented lesion (0.5%, stellate pseudoscar; 7.6%, idiopathic guttate hypomelanosis). Harmful treatment with systemic antifungal therapy was used in subungual melanoma (58.0%). Harmful management of senile comedone, subungual melanoma and acral lentiginous melanoma was significantly found in physicians given the incorrect diagnosis. (p = 0.027, p <0.001, p = 0.014, respectively).Conclusion: Most physicians recognized malignant lesions, benign erythematous or eczematous diseases in elderly skin. Surprisingly, almost all physicians couldn’t diagnose premalignant lesions and benign hypopigmented lesions.

Acquired ichthyosis, asteatotic dermatitis or xerosis? An update on pathoetiology and drug-induced associations.

Acquired ichthyosis (AI) is a relatively rare cutaneous entity characterized by transient, generalized scaling and pruritus in the absence of family history of ichthyosis or atopic disease. The hyperkeratosis in AI can range from the mild, white-to-brown scaling resembling that in ichthyosis vulgaris (IV) to the more prominent dark brown scaling phenotype, similar to that found in lamellar ichthyosis. The disease can wax and wane in relation to endogenous and/or exogenous factors. Histopathology of AI is similar to that found in IV. AI is usually of cosmetic concern to patients but can, in some cases, reflect the presence of more serious conditions, including malignancies, autoimmune diseases or metabolic disorders. In some cases, AI can be an adverse effect of a medication or the cutaneous symptom of a toxic exposure. Other conditions, such as severe xerosis or eczema, can present with clinical findings similar to AI, making diagnosis a challenge. Furthermore, cases of AI are sporadic throughout the literature and have been documented across a wide variety of medical settings distinct from dermatology, which often contribute to misdiagnosis of this disease. Definitive management requires prompt identification and treatment of the inciting factors combined with conservative therapies, which can include topical emollients, keratolytics, retinoids or corticosteroids, and in rare cases, oral retinoids.

Dermatoses among snow skiers in North India

Background: Snow skiers are directly exposed to a variety of extreme environmental conditions, which may lead to numerous physiological and pathological changes in the skin, and potentially increased chances of various specific and non-specific skin diseases. Although there are studies on skin diseases caused by exposure to cold and high altitudes, yet those on snow skiers are scarce as the study population is small. Objective: This study was undertaken to observe various dermatoses existing exclusively in snow skiers. Methods: It was a descriptive, cross-sectional, community-based study conducted at the world-famous ski resort Gulmarg Kashmir in North India. The initial questionnaire-based assessment and the subsequent examination of those exhibiting skin involvement were undertaken by visiting places of accommodation for snow skiers as well as on-spot visits to skiing slopes. Result: The most common dermatological manifestations in our study were dryness (xerosis) and its related aftereffects such as pruritus and chapping of the lips, followed by UV-related skin damage such as whole-face tanning, various types of infections and infestations, and endogenous eczema, including seborrheic and xerotic eczema. Direct cold-related injuries such as perniosis and various forms of urticaria were also common presentations. Conclusion: Snow skiers are especially susceptible to a variety of dermatoses because of exposure to cold conditions and direct contact with the snow. Proper protective measures against cold and snow and awareness about preventive strategies may decrease the chances of snow skiers developing various dermatoses, thereby reducing morbidity and work and economic loss.

Diagnostic keys for disseminated eczema: experience of a Dermatitis Contact unit (2003-2019)

The aim of this study was to establish the diagnoses of patients with disseminated eczema and analyze the allergens involved in disseminated eczema due to allergic contact dermatitis. We analyzed the data from patients with a diagnosis of disseminated / generalized eczema who had undergone anamnesis, physical examination and patch tests in a Contact Dermatitis consultation from 2003 to 2019. Allergic contact dermatitis was the most frequent diagnosis, folowed by atopic dermatitis, asteatotic eczema, and gravitational eczema. The allergens most frequently involved in allergic contact dermatitis were isothiazolinones, topical medications, paraphenylenediamine, and fragrances. Allergic contact dermatitis caused almost half of the cases of disseminated eczema. It would be therefore advisable for patients with disseminated eczema to be assessed at a Contact Dermatitis unit and undergo patch tests.

Diffuse plate-like sheets of desquamation

Diffuse plate-like sheets of desquamation

Proteoglycan Combined with Hyaluronic Acid and Hydrolyzed Collagen Restores the Skin Barrier in Mild Atopic Dermatitis and Dry, Eczema-Prone Skin: A Pilot Study.

Dry and eczema-prone skin conditions such as atopic dermatitis and xerotic eczema primarily indicate an impaired skin barrier function, which leads to chronic pruritus. Here, we investigated the effects of a novel emollient containing H.ECMTM liposome, which contains a soluble proteoglycan in combination with hydrolyzed collagen and hyaluronic acid. A prospective, single-arm study was conducted on 25 participants with mild atopic dermatitis or dry skin to assess the hydration and anti-inflammatory effect of the novel emollient applied daily over four weeks. All efficacy parameters, including itching severity, transepidermal water loss, and skin hydration, improved significantly after four weeks. The in vitro and ex vivo studies confirmed the restoration of the skin’s barrier function. The study revealed the clinical and laboratory efficacy of H.ECMTM liposome in reducing itching and improving the skin’s barrier integrity. Thus, the use of H.ECMTM liposome can be considered a therapeutic option for dry and eczema-prone skin.

Prevalence of eczema among older persons: A population-based cross-sectional study.

Background There are very few population-based studies on the prevalence of eczema among older persons Aims To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes.

Incidence of Adverse Cutaneous Reactions to Epidermal Growth Factor Receptor Inhibitors in Patients with Non-Small-Cell Lung Cancer

Background: Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients’ quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms. Objectives: To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC. Methods: We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events. Results: Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions. Conclusions: A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.

A Case of Marked Elevation of Squamous Cell Carcinoma Antigen Level Due to Asteatotic Eczema after Surgery for Tongue Carcinoma

A Case of Marked Elevation of Squamous Cell Carcinoma Antigen Level Due to Asteatotic Eczema after Surgery for Tongue Carcinoma

Geriatric dermatosis; The concerns of aging skin.

Objectives: To study the cutaneous manifestations in elderly and their association with gender. Study Design: Cross Sectional study. Setting: Sir Syed Hospital Karachi. Period: Jan 2016 to Jan 2018. Material &amp; Methods: Total 217 geriatric cases (&gt;60 years; both genders) were included from outdoor dermatology clinic. The previous pregnancy, lactation, severe systemic disease and drug induced skin changes were excluded. The association of skin manifestation with gender was analyzed by Chi-square test with significant p&lt;0.05. Results: Among 217 cases, there were 126(58%) females and 91(42%) males. Mean age was 69.3+4.99 years. Wrinkling was seen in 92%, skin laxity in 54.8%, xerosis (43%), dryness (65%), sagging (46%), pigmentation (37%), eczema (25%), sparse hair (21%), skin atrophy (19%), tinea (13%) and LSC (10%). While herpes zoster, psoriasis, onychomycosis, tinea corporis ,asteotic eczema in 7%. Folliculitis 6%, scabies and bullous pemphigoid seen in 5%, while lichen planus, actinic elastosis, BCC, Prurigo nodularis in 3%. Cellulitis, pediculosis, Seborrheic Dermatitis and contact dermatitis were seen in 2% followed by 1% cases of warts, candidiasis, photodermatosis and SCC seen in our study. Folliculitis (6%) was the most frequent bacterial infection followed by impetigo (0.9%). Herpes zoster (6.5%) was frequent among viral infections followed by warts (0.9%) and HSV-1 (0.9%). Tinea (13.4%) was most frequent fungal infection followed by onychomycosis (7%) and candidiasis (0.9%). Scabies was most common parasitic infection (4.6%) followed by pediculosis (2.3%). Eczema seen in 24.8%. The benign dermatosis, Actinic elastosis was frequent (3.2%), stucco keratosis 4(1.8%), Keratoacanthoma (0.9%). Amongst malignancies, BCC was common (3.2%), followed by SCC (1.4%). 5% Bullous Pemphigoid cases were found. The psychocutaneous disorder included LSC (10%), prurigo nodularis (2.8%) and neurotic excoriation (0.9%). Wrinkling, sagging, dryness of skin, actinic keratosis, actinic elastosis was found to be associated with female gender, however cellulitis, squamous cell carcinoma and asteatotic eczema with male gender. Conclusion: Geriatric population is facing multiple dermatological concerns. Contributory factors being the natural aging process, exposure to UV radiation, pathogens, dryness, humidity, temperature and chemical irritants. Female geriatrics are prone to wrinkling, sagging, dryness of skin and male geriatrics to basal cell carcinoma. There is need to address the skin problems in elderly for better quality of life in geriatrics.

The High Prevalence of Skin Diseases in Adults Aged 70 and Older.

To determine the prevalence of skin findings and skin diseases in adults aged 70 and older, and to study the association between cutaneous diseases and socioeconomic status (SES), sex, and living status in the older population. Cross-sectional study of Finnish adults aged 70 to 93 as part of the Northern Finland Birth Cohort 1966 Study. Skin examination data were available for 552 adults. A whole-body skin examination was performed by dermatologists. The associations between skin diseases and SES, sex, and living status were analyzed. Nearly 80% of the adults had at least one skin disease that required further treatment or follow-up. More than one-third of the study cases (39.1%) had three or more simultaneous skin diseases. Skin diseases were more common in men than in women (P < .001). The most common skin diseases were tinea pedis (48.6%), onychomycosis (29.9%), rosacea (25.6%), actinic keratosis (22.3%), and asteatotic eczema (20.8%). Some association was found between skin diseases and SES and living status. A whole-body clinical skin examination is important because it reveals important diagnoses.

Dermatologic Lesions in Geriatric Patient with Diabetes Mellitus

Introduction: In geriatrics, there are changes in structure and function results in histopathological, physiological and clinical skin changes. The conditions can cause morbidity and decreases the quality of life of patients. This study was the first study that provide the characteristics of geriatric skin disorders in Dr. Mohammad Hoesin Hospital Palembang.&#x0D; Methods: This study was descriptive observational with cross-sectional design using total sampling method performed among patients in Geriatric Outpatient Clinic, Dermatology and Venereology Outpatient Clinic and geriatric inpatient room in Dr. Mohammad Hoesin Hospital on July-September 2019.&#x0D; Results: Physiological skin changes in geriatrics include xerosis cutis (13,95%), seborrheic keratosis (13,17%), guttate hypomelanosis (8,5%), senile lentigen (6,97%), freckle (2,32%), periorbital hyperpigmentation (1,55%), senile purpura (0,77%) and poikiloderma civatte (0,77%). The most skin disorder found were lichen simplex chronicus (11,1%), pressure ulcers (9,25%), senile pruritus (8,32%), asteatotic dermatitis (6.47%) and candidiasis (3,7%). The most common comorbid condition were diabetes mellitus in 16 patients (22,5%), CVD in 7 patients (9,9%), hypertension in 6 patients (8,5%), AKI in 6 patients (8,5 %), and HHD in 4 patients (5,6%). Diabetes mellitus was significantly associated with xerosis cutis (p = 0,0007), senile pruritus (p = 0,015), and guttate hypomelanosis (p = 0,016).&#x0D; Conclusion: The most physiological skin changes found in geriatric patients in Dr. Mohammad Hoesin Hospital were xerosis cutis, seborrheic keratosis, and guttate hypomelanosis, while skin disorder were lichen simplex chronicus, pressure ulcer, and senile pruritus. Diabetes mellitus was significantly associated with skin disorders.

Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India.

Background:Often quoted as ”heaven on earth,” Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group.Aims:To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics.Methods:This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016–17 and 2017–18. The data were tabulated and analyzed with Chi-square test for discrete variables and t-test for continuous variables, using OpenEpi. A P value of less than 0.05 was taken as significant.Results:The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population.Conclusions:Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.

Pattern of lower leg and foot eczema in patients attending a tertiary care hospital in North East India

Pattern of lower leg and foot eczema in patients attending a tertiary care hospital in North East India - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.066, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol