FIGURE 65.1 Infant with atopic dermatitis on the cheeks (Reprinted with permission from Goodheart HP Goodheart’s Photoguide to Common Skin Disorders Philadelphia, PA: Lippincott Williams & Wilkins; 2009:52.) FIGURE 65.2 Nummular dermatitis (Reprinted with permission from Lugo-Somolinos A, McKinley-Grant L, Goldsmith LA, et al VisualDx: Essential Dermatology in Pigmented Skin Philadelphia, PA: Lippincott Williams and Wilkins; 2011.) Asteatotic Eczema Asteatotic eczema, also called winter eczema, xerotic eczema, and eczema craquele, is a pruritic condition in which the skin is dry and cracked with red fissures and scale ( Fig 65.3 ) The skin has the appearance of cracked porcelain and patients may complain of burning and redness upon application of lotions or creams The most common sites are the extremities It tends to occur in adolescents during the winter and is associated with overbathing with drying soaps (often strongly scented body washes) Use of a gentle soap and petrolatum-based ointment or thick emollient applied twice daily is effective treatment in most cases If needed, mid- to high-potency topical corticosteroid ointments can be used for flares Dyshidrotic Eczema Dyshidrotic eczema, also called pompholyx, involves the hands and feet There is sudden onset of pruritic, tiny, clustered, deep-seated vesicles that look like tapioca pearls ( Fig 65.4 ) With time, scaling, lichenification, and painful fissures occur Lesions appear on the palms, soles, and lateral digits The process may be acute, chronic, or recurrent It may be associated with hyperhidrosis and may also occur as a form of an Id reaction (autoeczematization) in the setting of a remote contact dermatitis or tinea capitis Approximately 50% of patients have an atopic background Acute presentations may be treated with thick emollients and potent topical corticosteroids, which can be applied under white cotton gloves nightly, if needed, to increase efficacy FIGURE 65.3 Asteatotic eczema (Reprinted with permission from Goodheart HP Goodheart’s Photoguide of Common Skin Disorders 2nd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2003.) Lichen Simplex Chronicus Lichen simplex chronicus refers to a chronic, localized lesion resulting from repeated rubbing and scratching It has a predilection for the sites that are easily reached, such as the arms, legs, ankles, neck, and the anogenital area It is rare in young children but fairly common in adolescents and adults It may occur in a pre-existing area affected by dermatitis Typical lesions are single or multiple oval plaques from to 15 cm in size The skin is reddened and slightly edematous Chronic lesions consist of welldemarcated areas of dry, thickened, scaly, hyperpigmented, or hypopigmented plaques, often with lichenification (accentuated skin markings) Intense pruritus is a hallmark While topical corticosteroids can be effective, some lesions may respond best to occlusion with a corticosteroid-impregnated tape or intralesional corticosteroid Monitoring