Predictive Clinical Features of Eczema Craquelé Associated with Internal Malignancy

Abstract

Objective: To describe a series of hospitalized patients with eczema craquelé (EC) and the possible correlations between clinical features of EC and cancer in an open prospective observational study. Patients and Interventions: The study population comprised 68 consecutive patients included between January 1, 1999 and December 31, 2000 who were followed up through December 2004. All patients who had localized or generalized EC were included. Patients underwent complete clinical examinations, routine laboratory tests, chest x-rays, abdominal ultrasound, and cutaneous biopsies performed on EC. Main Outcome Measures and Results: Rates of EC associated with cancer, clinical features of eczema, rate of recalcitrant eczema, relationship to other clinical prognostic factors, and paraneoplastic evolution were evaluated. Cancer was diagnosed in 32 patients (47%). We observed a significant difference in the presenting clinical signs of EC between patients with malignant tumors and patients without cancer. In patients with malignancies, EC was widespread on the trunk and we noted deep red and inflammatory fissures. In all cases, EC led to the discovery of malignancy or recurrence of cancer. Conclusion: Widespread EC, topical corticosteroid resistance, and deep red and inflammatory fissures were significantly correlated with neoplasia.

What Do You Mean by Eczema Craquelé?

“…Extensive or generalized forms involving the trunk as well as the limbs are unusual and should raise the suspicion of internal malignancy. A series of publications referenced in the paper by Sparsa et al [1] clearly points to this association.…”

“…This has recently been shown using skin capacitance imaging [4][5][6] . In these instances, the altered strucIn this issue of Dermatology, a link is highlighted between eczema craquelé, also called asteatotic eczema, and internal cancers [1] . Both of the terms used to identify this distinctive skin condition refer to a descriptive clinical presentation without any proper appreciation of its pathobiology.…”

Eczema craquelé, an uncommon clinical manifestation of myxedema

“…Sparsa et al reported two additional cases of hypothyroidism presenting with EC but did not provide any information about the clinical or histological features of EC in their patients. Also, in these cases hormone replacement therapy resolved EC [7]. Histology was not performed in any of the five cases.…”

Eczema craquelé associated with antiviral treatment for chronic hepatitis C

“…Other predisposing factors are malnutrition (zinc deficiency), prolonged corticosteroid use, anti-androgen therapy, prolonged diuretic use, atopy, myxedema, and malignancy. 5 Treatment for eczema craquelé is based on suspending the causal factor, using emollients to hydrate the skin, reducing the use of soaps and detergents, and showering at room temperature. In more severe cases or in those unresponsive to this therapy, topical corticosteroids are applied on the lesions.…”