Complaints & connections · borters.ch
Eczema craquelatum · Dermatitis asteatotica
A net of fine cracks on dry skin, late winter, mostly on the lower legs — it only itches once scratched. The barrier is what gets treated, not the inflammation.
Also known as: asteatotic eczema · eczema craquelé · xerotic eczema · winter itch
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The topmost layer of the skin holds water like a wall of bricks and mortar: cells with fats between them. If the mortar dries out, the wall cracks — and that is exactly what this eczema looks like: a dry, dully scaling surface with a net of fine red lines, like the crazing on old porcelain or a dried-out river bed. It sits by preference on the shins and lower legs, often also above the heel, on the forearms, the flanks and over the hips. The timing is as typical as the picture: late winter and spring, after four or five months of heated air, little light and hot showers. Often it does not itch by itself but only once one rubs or scratches at it — and then the circle starts that draws the whole thing out. It is favoured by age, frequent washing with soap, water tablets, cholesterol-lowering drugs, an underactive thyroid and an empty iron or zinc store. The most important point about it: it is not an illness of its own to be fought, but a barrier that has too little fat. What helps is therefore not primarily an ointment against inflammation but consistent greasing — and carrying on with the cream when there is nothing left to see. Anyone who creams only during a flare gets it back every winter.
The lever is the prevention, not the flare. Grease daily from October, at least until April — then the February picture often does not arise at all.
The cream holds in the water still in the skin. After showering, just dab dry and cream at once — that does much more than the same amount on dry skin hours later.
The drier the skin, the greasier the base: ointment lasts longer than cream, cream longer than lotion. Additions like urea or glycerine bind water — on cracked skin urea can sting, so start with the greasy base alone.
Hot water and soap dissolve out exactly the fats this is about. Five lukewarm minutes are enough, and soap is only needed where it smells — not on the shins.
Below forty per cent humidity the skin dries out overnight. A hygrometer costs little and makes visible why February is worse than October.
An old, well-tolerated remedy for large areas: it calms and leaves a film. Cream afterwards all the same — the bath does not replace the greasing.
If it is inflamed and itching, a suitable ointment settles things within a few days. Used too weakly and for too long it prolongs the problem — the greasing carries on throughout.
Two values that can explain a stubborn dryness returning every year — and both can be treated. Measuring once is enough if they are in order.
Cool it, press briefly, keep the nails short, thin cotton gloves at night. Wanting not to scratch is not enough — something to do instead is needed.
An eczema that stays for weeks in the same place, is sharply bordered, sits on one side only or does not respond to consistent care belongs looked at — not every dry patch is dryness.
A rich base works if it goes on within three minutes of showering, onto skin that is still damp — then it seals the water in; on dry skin the same cream works distinctly less well. Urea binds water but stings on cracked skin. Cortisone is meant for the inflamed spots and for days, not for the whole area. Hot, long showers remove the fats the cream is supposed to replace.
Skin moisture falls as soon as the air humidity drops below about forty per cent — in heated rooms in winter, twenty to thirty per cent is usual. Sebum production falls measurably from about forty, which is why it becomes more common with age. Skincare shows after two to four weeks. Five to ten minutes of showering at at most about thirty-seven degrees costs less fat than longer, hotter showers.
A dully scaling surface covered by a pattern of fine red lines — like a dried-out river bed. This picture is so characteristic that it almost carries the diagnosis on its own.
Late winter and spring, after months of heated air, and gone by itself in summer. This return without anything being done is a strong argument against an allergy tied to a particular substance.
Unlike allergic eczema the itch does not stand at the beginning. It arises from friction, wool, hot water and the scratching itself — and then the circle keeps itself going.
Shins and lower legs first, often also above the heel, then forearms, flanks and over the hips. Face, armpits and groin usually stay clear — the skin is oilier there.
Age, hot and frequent showering with soap, dry heated air, wool directly on the skin, water tablets, cholesterol lowerers — and the habit of creaming only when something is visible.
Weeping, yellow crusts, growing redness with warmth and pain, a red streak up the leg or fever: then the scratched skin has become infected as well and needs a treatment of its own.
An underactive thyroid makes the skin dry, rough and scaly and lowers the oil production. It is the most common internal cause and is found with a single value.
An empty store makes dry, itch-prone skin long before any anaemia becomes visible. With recurring itching without a rash it is one of the first values.
A lack causes dry, eczema-like skin, cracked corners of the mouth and poor healing. It is more common than assumed with little meat and pulses, with chronic diarrhoea and in later life.
Almost regularly low here at the end of winter — exactly when this eczema appears. Direct proof of a connection is missing; correcting it is worthwhile regardless.
A weak kidney causes dry, itching skin and is among the internal causes thought of with lasting itching.
A raised sugar draws fluid out of the skin through the urine and makes it dry and prone to infection. With widespread, stubborn dryness it belongs with it.
The skin renews itself every four weeks and needs zinc for it. A lack makes exactly this picture: dry, rough, eczema-like, with cracked corners of the mouth beside it.
A component of the fats between the skin cells. Oily sea fish, linseed and rapeseed oil supply the building blocks from inside — as a replacement for creaming it does not work, as an addition it makes sense.
An empty store makes the skin dry and lowers the itch threshold. With any stubborn itching ferritin belongs with it — not just the blood count.
Low in almost everyone at the end of winter — exactly when this eczema comes. Correcting it is simple; direct proof for the skin is missing.
Drinking alone does not make dry skin soft — the loss goes outwards, not inwards. But a clear fluid deficit worsens it measurably, and many people drink less in winter.
1–2 g EPA+DHA a day over 8–12 weeks; the effects on the skin barrier are small. Re-fatting care twice a day has clearly better numbers for winter skin — from inside comes an addition at best.
Used for decades in atopic eczema. The pooled studies at 1–6 g a day over 12–16 weeks found no difference from placebo — in the United Kingdom the licence for it was withdrawn for that reason.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
After menopause the skin’s fatty film decreases and the barrier holds less water. That is why winter skin increases over the years — and why care is then not cosmetics but treatment.
An underactive thyroid causes dry, rough skin and dull hair — in winter it just stands out less. If the dryness stays through the summer, the value belongs measured.
Dry winter skin comes mainly from heated air and hot showers, not from drinking too little. More water alone does not improve it in studies — greasy care from outside does.
A low vitamin D level is measurable in many from November to April. Two portions of oily sea fish a week also supply omega-3 for the skin barrier.
Moisturising and cooling. On very dry winter skin the fat component is missing — aloe alone tends to dry out after evaporating; it belongs under a greasy cream.
The skin barrier needs fatty acids. The effect shows over weeks and is smaller than that of good greasy care from outside.