Synopsis
Distinguish coin-shaped discoid eczema from fissured asteatotic eczema, exclude dermatophyte infection and venous disease, and treat dryness and inflammation without masking important mimics.
- Discoid eczema forms very itchy round or oval plaques, often weepy and crusted early and dry or scaly later; it commonly mimics tinea corporis.
- Asteatotic eczema produces superficial intersecting cracks on very dry skin, often shins of older adults in cold dry conditions.
- On brown or black skin, active discoid plaques may appear dark brown, purple or paler and often leave persistent pigment change.
- Scrape an untreated active scaly border when dermatophyte infection is plausible before escalating topical corticosteroid.
- Reduce hot bathing and harsh soap, use a generous leave-on emollient and apply a site-appropriate topical corticosteroid to active plaques for a defined course.
- A solitary plaque that remains indurated, ulcerated or treatment-resistant needs biopsy consideration rather than repeated empirical cream.
- For Discoid and asteatotic eczema, document body sites, severity, sleep and function, recent treatment, infection features and what the patient can realistically apply each day.
- In Discoid and asteatotic eczema, reassess the diagnosis when a well-used, correctly potent regimen fails rather than repeatedly intensifying treatment without examining adherence, exposure and mimics.
Key red flags
Systemic illness, painful expansion, purpura, widespread detachment, unilateral ulceration, palpable tumour, treatment-resistant annular disease or major lower-leg oedema requires broader investigation.
A solitary enlarging indurated plaque with bleeding, ulceration or failure of adequate therapy requires prompt specialist assessment.
Investigation priorities
Distinguish discoid and asteatotic patterns from psoriasis, venous disease and a fungal reservoir.
Management branches
Craquelé fissures occur on dry skin without infection, tumour features or major venous disease.
- Shorten hot washing, stop harsh soap and apply a rich fragrance-free leave-on emollient at least twice daily and after washing.
- Use a site-appropriate topical corticosteroid on inflamed fissured areas for a defined short course while continuing emollient beyond clearance.
- Review heating, humidity, mobility and adequate product quantity and reassess if fissures become painful, wet or widespread.
Key medicines
Betamethasone valerate 0.1% creamApply a thin film to active trunk or limb plaques once or twice daily for up to four weeks, reducing frequency when inflammation is controlled.Avoid face, folds, infection, large areas and occlusion unless directed; review atrophy and systemic absorption and stop diagnostic masking when a plaque fails to respond.
Hydrocortisone 1% creamAdults apply thinly once or twice daily for no more than seven days under the product licence on appropriately selected mild or thin-site inflammation.Do not use on untreated infection, eyes or suspicious lesions; prolonged use and sensitising excipients can worsen diagnostic uncertainty.