Chronic eczematous eruptions of aging: a clinical practice review

Chronic eczematous skin disorders that first appear in later life are poorly characterized, partly because existing terminology is inconsistent and often conflates morphologic descriptors with specific diagnoses. This review introduces chronic eczematous eruptions of aging (CEEsA) as an umbrella term, summarizes current knowledge on its epidemiology, etiologies, and clinical presentation, outlines best practices in management, and highlights gaps requiring further investigation. CEEsA frequently present as ill defined, intensely pruritic eruptions on the trunk and extensor limbs, are often refractory to standard topical therapies, and may be precipitated by calcium channel blockers or thiazide diuretics. A structured diagnostic algorithm-incorporating exclusion of mimickers (e.g., tinea pedis-linked auto-eczematization, scabies, contact dermatitis, cutaneous T-cell lymphoma), lesional biopsy, patch testing, and strategic drug withdrawal-is essential before escalating to systemic therapy. This approach helps avoid unnecessary treatment or other etiologies with different management. Although traditional broad spectrum immunosuppressants carry age related safety concerns, emerging targeted agents that dampen type 2 cytokine signaling (dupilumab, tralokinumab) or Janus kinase pathways (upadacitinib) show promising efficacy and tolerability in small case series of CEEsA, including idiopathic forms. Recognizing CEEsA as a distinct clinical construct should streamline nomenclature, sensitize clinicians to reversible drug triggers, and catalyze research into pathophysiology-specific, age appropriate treatments for this under studied geriatric dermatology domain.