Introduction:
Nummular means round or "coin shaped." Nummular eczema is an inflammatory skin condition with well-defined round-to-oval reddish plaques. Nummular dermatitis can be an independent disease or may be associated with diseases like contact dermatitis, atopic dermatitis, and asteatotic eczema. Nummular eczema was first termed in 1857 by Deverigie as coin-shaped lesions on the upper extremities. Ever since, it has been reported in all body parts but is more common in the upper and lower extremities.
How Is It Otherwise Known?
Nummular eczema is also known as,
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Discoid eczema.
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Orbicular eczema.
What Causes Nummular Eczema?
The exact cause of nummular eczema is not known. Some contributing factors of nummular eczema are:
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Personal or family history of asthma, allergies, and atopic dermatitis.
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Stress.
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Temperature changes.
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Dry skin.
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Environmental irritants, such as soaps, metals, and formaldehyde.
The common triggering factors include:
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Heat and humidity.
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A skin injury and infection, as in a bug bite or scrape.
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Alcohol.
Who Is at Risk for Nummular Eczema?
The following conditions increase the risk of developing nummular eczema:
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Cold and dry climate.
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Swelling or poor blood flow to the legs.
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History of any type of eczema.
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Any skin injury, as in insect bite or abrasion.
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Surgery.
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Certain medications.
What Are the Symptoms of Nummular Eczema?
The most common symptom of nummular eczema is a coin-shaped lesion on any body part. The lesions often develop on the extremities but may spread to the chest and hands. Tiny nodules and blister-like lesions are often the first sign that appears after a skin injury. The tiny nodules crust over and join together, creating round to oval coin-shaped spots. In darker skin tone people, these spots are brown colored, while in lighter skinned people, the spots are pink or red colored. These raised, scaly spots usually last for weeks or months. The spots can be extremely itchy. This itch worsens while relaxing or trying to sleep. Some people experience burning or stinging sensations. The skin between the spots becomes extremely dry. Scratching the itchy spots can break open the skin and may develop an infection. An infected site appears as yellow or golden crusts, streaks of red or brown, swelling, pus discharge, and pain. As the spots begin to clear, they flatten out. The center of the spot clears first with skin discoloration. Sometimes, new spots may begin as older ones clear. Large, raised patches are seen if flare-ups progress instead of the classical coin-shaped spots.
How Is Nummular Eczema Diagnosed?
Nummular eczema is diagnosed by,
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Complete medical history.
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Complete clinical examination of the skin. A superficial skin scraping may also be taken for investigation.
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An allergy test is suggested when an external allergic reaction is noted.
How Is Nummular Eczema Treated?
Medications and lifestyle changes can help to treat nummular eczema.
1) Medications:
Corticosteroids, Tacrolimus ointments, Pimecrolimus cream, or tar cream may be prescribed. Sometimes oral and intralesional steroid therapy may be prescribed depending on the lesion severity. You may also need to see a doctor to rule out other skin disorders that can look like nummular dermatitis. Cover the affected area with moist bandages and protect it while it heals. Consuming antihistamines can relieve itch and discomfort. Antibiotics like Erythromycin, Flucloxacillin are often prescribed in case of infection. Ultraviolet light treatment is given in case of severe itching. Daily hydrate skin, especially on the legs with moisturizer after showering. Sometimes, Methotrexate, Azathioprine, or Cyclosporine are also prescribed.
2) Lifestyle Changes:
There is no cure for nummular eczema. However, lifestyle changes and avoiding triggers can help manage the trigger.
For this, try to avoid the following:
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Any irritants like wool, household cleaners, and chemicals may trigger your symptoms.
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Too much bathing with hot water and harsh soap.
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Stress.
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Use fragrance-free fabric softener and dryer sheets.
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Activities that scrape, cut, and abrade the skin surface.
3) Nummular Eczema Diet:
At present, there is no specific diet for nummular eczema. But it is better to eat a nutrient-rich, balanced diet and maintain moderate body weight.
Foods to Eat:
Some healthy foods that possess anti-inflammatory properties are:
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Fish rich in omega-3 fatty acids or fish oil supplements.
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Plant-based omega-3 sources - flaxseeds, walnuts, and green leafy vegetables.
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Healthy monounsaturated fats - olive oil and canola oil.
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Antioxidants and healthy carbohydrates - fruits, vegetables, and whole grains.
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Anti-inflammatory - turmeric and ginger spices.
Foods to Avoid:
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Trans fats or hydrogenated oils - margarine and fried foods.
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Unhealthy saturated fat - butter, full-fat dairy, the skin of poultry, red meats.
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Omega-6 fatty acids - corn or cottonseed vegetable oils.
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High sugar and refined carbohydrates foods - highly processed foods.
How to Prevent Nummular Eczema?
Self-care helps to get better treatment results and have fewer new flare-ups. These self-care tips include:
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Take lukewarm water baths and showers for not more than 20 minutes.
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Apply a fragrance-free moisturizing cream or ointment after each shower.
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Use mild, odorless, and less allergic skin care products for dry skin.
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Keep a humidifier when indoor air is dry.
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Protect the skin from any injury or harsh chemicals.
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Avoid scraping, cuts, and other injuries, and protect the skin with gloves during household chores.
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To prevent any extra irritation, wear cotton gloves under waterproof gloves.
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Reduce stress through meditation, yoga, and biofeedback therapy.
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Avoid overheating, as sweating can irritate sensitive skin, leading to a flare-up.
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Avoid sitting next to a fireplace, campfire, or anything that can increase body heat and dry the skin.
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Wear loose-fit clothes that are made of soft and breathable fabric.
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Rough-feeling fabric like wool, rayon, nylon, polyester, acetate, latex, and spandex and tight clothing can irritate the skin and trigger flare-ups.
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Drink alcohol in moderation or quit.
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Heavy drinking can trigger new flare-ups.
What Is the Differential Diagnosis of Nummular Eczema?
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Tinea corporis.
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Plaque psoriasis.
What Is the Prognosis of Nummular Eczema?
The prognosis is usually good. With appropriate treatment, nummular eczema improves within one year. However, this is a chronic condition, with some lesions completely fading off and some resolving over time. Lesions on the legs and feet often heal late and may leave some spots.
Conclusion:
Nummular eczema is a chronic skin inflammatory condition that produces blisters, breaks open, and oozes out. It is a non-contagious skin condition. Although the symptoms of nummular eczema are troublesome, they can be treated completely with early diagnosis, proper medications, and some healthy lifestyle changes.
