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Nummular Eczema

It may be a manifestation of atopic dermatitis, especially in children. More commonly, it occurs as a


reaction to topical irritants, or as a manifestation of winter dermatitis.
There are two peaks of occurrence of nummular eczema: it occurs in young adulthood and in old
age. It also peaks in the fall and in the winter.
The Causes of Nummular Eczema
The causes of nummular eczema are many, and, in some cases, no cause could be verified.
Associated with atopic dermatitis, mainly in young children.Staphylococcal infection, can be the
primary event, or may be a complicating secondary event in nummular eczema.Local physical or
chemical injury has been hypothesized as a cause of discoid eczema.Contact allergy and

sensitization to aloe, hair removal creams, mercury etc have preceded the development of the coin
shaped itchy skin rashes in some cases.Dry skin typically causes dry discoid eczema when
severe.Excessive alcohol consumption as a cause of nummular eczema is an interesting association
that has been noted by some.Drug eruptions: Methyldopa, gold salts etc are reported to have caused
nummular eczema rashes in some patients.Emotional stress, though may not be the primary cause in
nummular eczema, definitely contributes to the exacerbation and chronicity of many cases of
nummular eczema.The Clinical Features of Nummular Eczema
Single or multiple round, scaly coin shaped patches appear mainly on the back of the hands,
forearm, lower legs and buttocks. These intensely itchy skin rashes mostly show dry, eroded surface,
but at times can resemble acute eczema, with redness, oozing and vesiculation. The rashes may
appear singly or at a time.
Ring worm infections, psoriasis and dry eczema are the main skin diseases that have to be
differentiated from nummular eczema. Ringworm patches show central clearing of the scales with
active borders, where as in nummular eczema the scaling is uniform throughout. Dry eczematous
patches resemble the nummular eczema at times; the presence of dry, cracked skin around clinches
the diagnosis.
Treatment of Nummular EczemaAvoidance of irritants, if any.Acute stage: Wet compresses for 10-15
minutes, three times daily.Topical steroids of moderate strength at night.Emollients in the
morning.If secondary bacterial infection is suspected, a course of antibiotics will clear the itchy skin
rash faster.For thick patches, intralesional steroid injection is beneficial.Tar ointments are useful in
chronic dry discoid patches.Phototherapy will be effective for recalcitrant nummular
eczema.Sedating antihistamines like hydroxyzine will help relieve the itching.In severe exudative
and generalized cases, bed rest and removal from stressful environment is essential.Other
supportive measures like stress management, biofeedback techniques etc are also helpful in treating
resistant cases of nummular eczema.Reference Atopic Dermatitis, in Rooks Textbook of
Dermatology, 7th Edition, 2004 Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth
Ed, 2005Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the
options available. No diagnosis should be made or treatment undertaken without first consulting
your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The
images provided are for illustration purpose only.