Endgames onExamination Question


BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6509 (Published 13 October 2011) Cite this as: BMJ 2011;343:d6509

This week’s question is on eczema and is taken from the onExamination revision questions for the MRCGP exam.

Which of the following describes a patient with asteatotic eczema?

  • A: A 5 year old girl with lichenification and scratch marks in the antecubital and popliteal fossae.

  • B: A 45 year old man with well demarcated, coin shaped plaques of eczema.

  • C: An 81 year old woman who has developed cracked fissured skin on her lower legs with a “crazy paving” appearance.

  • D: A 70 year old woman with a past history of deep vein thrombosis and thrombophlebitis who complains of dry skin on the medial aspect of the lower legs that has developed a red-brown discolouration.

  • E: A 31 year old woman who gets a recurrent vesicular eruption affecting her hands that seems to occur during spells of hot weather.


Answer C is correct.

There is a variety of different “types” of eczema. The patient in answer A has atopic eczema, B describes discoid eczema, D describes varicose eczema, and E describes pompholyx.

Asteatotic eczema is relatively common in elderly patients. It is a consequence of loss of epidermal lubrication. Precipitating factors include over-washing or over-scrubbing, inadequate removal of soap, diuretic use, and dry air with low humidity.

The description in the question is typical, with the dry, cracked skin taking on a “crazy paving” appearance. Treatment involves dealing with any precipitating factors and using topical emollients and topical steroids.


Cite this as: BMJ 2011;343:d5010

View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial