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Eczematids, also referred to as dry patches, present as small pinkish, rough patches that always give rise to secondary hypopigmentation. Indeed, the exact name of the condition is eczematid achromians. Dry patches are observed primarily in children with dry skin or eczema. The patches are more visible in summer with tanning of the normal surrounding skin.
They generally affect children between the ages of 3 and 16 years, but are also more rarely observed in adults. The patches are round or oval and measure 0.5 – 2 cm. Larger patches may be observed on the torso. Each patch develops through two stages and coexistence of patches of different ages is often observed. Initially, the patch is slightly dry or rough, and only rarely crusty. The associated redness is often discreet, only mildly red and sometimes even pinkish or almost invisible. The patches are often annular with the centre surrounded by a raised border. Itching is mild or absent. The initial phase then gives rise to secondary hypopigmentation. The patch appears depigmented and completely smooth and remains that way for several months until it the pigmentation returns spontaneously. The hypopigmented phase is much longer than the inflammatory phase. When depigmented, the patches are very visible in the summer or on dark skin. They are a common cause of doctor consultations in September. They are often mistaken for a fungal infection and treated as such.
Patients often present with several patches. In children, they are mainly observed on the face, principally on the cheeks, whereas in adolescents and adults, they are generally observed at the top of the arms, on the thighs, or on the shoulders and torso.
The period of development is very variable. In children, the patches recur for several years until puberty. Therefore, it is to be expected that these children will have white patches on their cheeks for several consecutive summers.
The white, smooth patches, which are a cause of worry and for consulting the doctor, cannot be treated. Pigmentation returns to the patches spontaneously, after a few months. In patients with dark skins, after summer, the skin usually becomes homogeneously coloured again towards Christmas time. The only phase that can be treated is the initial inflammatory phase but it is imperceptible and brief and often goes unnoticed.
First-line treatment essentially consists in application of a hydrating cream that has a beneficial effect on the pink, dry patches and mostly, limits recurrences. If the initial lesion is more noticeable, a cream containing copper and zinc and sold over the counter in pharmacies may be used. Distinctly red patches may be treated with a dermocorticoid. The shorter the inflammatory phase, the more inconspicuous the white patch that follows it.
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