Can eczema cause thickened skin and cracking?

Yes, Eczema Causes Both Thickened Skin and Cracking

Eczema definitively causes both thickened skin (lichenification) and cracking (fissures), representing the chronic and acute manifestations of the disease, respectively. 1

Mechanisms of Skin Changes in Eczema

Thickened Skin (Lichenification)

• Chronic eczema produces lichenification as a hallmark feature, resulting from repeated scratching and rubbing of affected areas over time 1
• This thickening represents dermal remodeling with fibrosis, mediated by periostin, which contributes to the characteristic leathery appearance of long-standing eczema 1
• Lichenification is accompanied by hyperpigmentation from increased epidermal melanogenesis and dermal pigment deposition 1

Cracking and Fissures

• Eczema causes general dry skin (xerosis), which progresses to inflammatory skin conditions including fissures 2
• The condition is characterized by dehydration of the stratum corneum, particularly during winter months when decreased humidity increases water loss 3
• Asteatotic eczema specifically presents with erythematous, dry plaques with fine crackling patterns 3
• Fissures develop on xerotic skin as a complication of the inflammatory process 2

Clinical Presentation Pattern

Acute vs. Chronic Features

• Acute eczema displays polymorphism with erythema, papules, vesicles, pustules, scales, and crusts 1
• Chronic eczema is represented by lichenification and hyperpigmentation, distinguishing it from acute presentations 1
• The "eczema triangle" concept describes this polymorphic evolution from acute to chronic states 1

Distribution and Recognition

• Eczema commonly affects flexural areas (folds of elbows, around neck) where chronic rubbing leads to lichenification 2
• General dry skin in the past year is a diagnostic criterion for atopic eczema 2

Management Implications

For Xerosis and Fissures

• Apply emollients liberally and frequently (at least twice daily) to the whole body to prevent dehydration and return moisture 2, 4
• Avoid hot showers and excessive soap use, which remove natural lipid from the skin surface 2
• Use dispersible cream as a soap substitute for cleansing 2
• Oil-in-water creams or ointments are preferred over alcohol-containing lotions 2

For Fissures Specifically

• Treat with propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing 2
• Alternatively, use antiseptic baths (potassium permanganate 1:10,000) or topical silver nitrate solutions to accelerate wound closure 2

For Lichenification and Inflammation

• Use topical corticosteroids as the mainstay of treatment, selecting the least potent preparation required to control the eczema 2
• For erythema and desquamation indicating ongoing eczema, apply topical steroid preparations such as prednicarbate cream 2
• Grade 3 erythema/desquamation warrants short-term oral systemic steroids 2

Critical Pitfall to Avoid

Do not overlook secondary bacterial infection, which commonly complicates eczema and presents with crusting or weeping 2, 5. Staphylococcus aureus is the most frequently detected infectious agent, requiring treatment with flucloxacillin 4, 5. Deterioration in previously stable eczema may indicate secondary infection or development of contact dermatitis 2.