II. Epidemiology
- Incidence increases with age (common in elderly)
III. Pathophysiology
- Related to abnormal keratin production
- Elderly have decreased skin Fatty Acids
- Results in decreased skin barrier and hydration
IV. Symptoms
-
Pruritus without rash
- Itching may be intense
- Sporadic occurrence
- Common Areas involved
- Anterolateral lower legs (most commonly affected)
- Nummular lesions are common on the legs in the elderly (and often very pruritic)
- Back and Flanks
- Abdomen and waist
- Arms
- Anterolateral lower legs (most commonly affected)
- Areas spared
- Axilla
- Groin
- Face and scalp
- Provocative factors
- Worse with cold, dry weather
- Examples: Winter or air conditioning exposure
- Palliative factors
- Improves with warm, humid weather
V. Signs
- Mild changes
- Faint reticulate pinkness
- Fine scale or cracks seen with tangential light
- Often affects legs (especially shins)
- Moderate to severe changes
- Dramatic deep redness and cracking
- May appear as cracked porcelain (Eczema Craquele)
- Nummular Eczema type lesions
- Dramatic deep redness and cracking