By Gary M. White, MD
Nummular eczema is a variant of eczema also known as discoid eczema in which lesions are "coin-shaped". Dry skin is the most common triggering factor. Prolonged and repeated water contact (e.g. swimming, long baths) may also contribute.
- Round, red, scaly lesions.
- Commonly mistaken for impetigo or ringworm (tinea)
- Key difference from tinea is that nummular eczema tends not to clear in the center
- Treatment requires a potent topical steroid, e.g. clobetasol. Triamcinolone will not do.
- Prevent recurrences by topical cream or grease immediately after daily shower. No lotions please.
Round, inflamed, scaly lesions occur in crops. Lesions are usually very pruritic. The extremities are preferred. The surface may be relatively dry or quite moist and crusted.
- Clobetasol ointment (or other potent topical steroid ointment) BID--immediately after the shower and then 12 hours later--x 7 days.
- Then emolliate long term with a cream or ointment. No lotions please.
The patient requires a potent topical steroid, e.g. class I-II. Hydrocortisone or triamcinolone will not be very effective. The topical steroid should be applied immediately after the shower or bath. As the condition clears the patient may be transitioned to a moisturizing cream (cetaphil or eucerin cream, Aquaphor, or vaseline). Failure of the patient to moisturize long term usually leads to recurrence. The dry skin handout may be given. If the condition worsens with topical steroids, rethink the diagnosis. Could it be tinea? (Tinea usually clears in the center whereas nummular eczema is inflamed throughout.) Or could it be secondarily infected with Staphylococcus? Adding an oral antibiotic might help clear the lesions.
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