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