Nummular Eczema

Nummular eczema, often known as discoid eczema, is a common type of skin inflammation. Its name is derived from the Latin word ‘nummus’, which means coin, referring to its coin-shaped red patches on the skin. It can be very itchy and uncomfortable, impacting your quality of life, and causing stress.

Anyone can get nummular eczema, but it’s more common in men than in women. It generally affects adults, with the first outbreak typically happening between the ages of 55 and 65. However, a younger group, primarily men between 15 and 25 years old, can also experience nummular eczema.

Types

Type 1: Classic Nummular Eczema

This is the most common form of nummular eczema and is often seen in people with a history of dry skin or atopic dermatitis. It shows up as red, itchy, coin-shaped patches, usually on the legs or arms. It can start off small but often spreads, with patches merging into one another. Think of it like a jigsaw puzzle where the pieces are patches of red, itchy skin.

Type 2: Wet or ‘Exudative’ Nummular Eczema

The second variant is wet, or ‘exudative’ nummular eczema. It’s just like classic nummular eczema but with an extra feature. The patches weep or ooze liquid, which can make it look wet. It’s as if the skin patch is crying. These “tears” can dry out, forming a crusty layer over the patch. This form is generally more uncomfortable because the oozing and crusting can cause pain and added itching.

Type 3: Nummular Eczema with Infection

Sometimes, nummular eczema becomes infected, creating a third variant. Just like when you get a cut and it gets infected, the same can happen with these skin patches. They might get larger, more painful, and might even give off a bad smell. This is when a healthcare professional’s help is needed to tackle the infection and manage the eczema.

Type 4: Nummular Eczema with Lichenification

Finally, we have nummular eczema with lichenification. This sounds complicated, right? But, think of ‘lichenification’ as ‘thickening.’ Over time, if you keep scratching the patch, the skin gets tired of being irritated and responds by getting thicker. This results in rough, tough skin areas that are even more itchy and troublesome.

Causes

Understanding the causes can help you manage this condition more effectively causes of nummular eczema.

1. Dry Skin: Dry skin is a major culprit behind nummular eczema. When your skin lacks moisture, it’s more prone to irritation and eczema flare-ups.
2. Cold Weather: Chilly weather can lead to dry skin, setting the stage for nummular eczema. Always moisturize your skin during winter to keep it healthy and hydrated.
3. Hot Showers/Baths: Long, hot showers or baths can strip your skin of essential oils, leaving it dry and vulnerable to nummular eczema.
4. Certain Soaps/Detergents: Some soaps and detergents can irritate your skin and trigger eczema outbreaks. Always opt for mild, fragrance-free products.
5. Allergens: Pollen, dust mites, and pet dander are common allergens that can cause nummular eczema flare-ups.
6. Wool and Synthetic Fabrics: These materials can irritate your skin and aggravate your eczema. Stick to soft, breathable fabrics like cotton.
7. Stress: Emotional stress doesn’t cause eczema directly, but it can trigger or worsen symptoms. Try stress-reducing activities like yoga or meditation.
8. Alcohol and Tobacco: These substances can disrupt your immune system and skin health, leading to nummular eczema outbreaks.
9. Certain Foods: Foods like dairy, eggs, nuts, and wheat can trigger eczema in some people.
10. Environmental Irritants: Smoke, pollen, and pollution can irritate your skin and trigger nummular eczema.
11. Insect Bites: Bites from mosquitoes and other insects can lead to nummular eczema in some people.
12. Excessive Scratching: Scratching your skin can lead to inflammation and eczema.
13. Infections: Certain bacterial, fungal, and viral infections can trigger nummular eczema.
14. Metals: Some people may react to metals like nickel, leading to nummular eczema.
15. Medications: Certain drugs, including antibiotics and antifungals, can cause nummular eczema in some people.
16. Heat and Sweat: Excessive heat and sweating can worsen nummular eczema.
17. Hormonal Changes: Hormonal shifts, like those during menstruation or pregnancy, can trigger eczema flare-ups.
18. Health Conditions: People with certain health conditions, like diabetes or autoimmune disorders, are more likely to develop nummular eczema.
19. Poor Nutrition: Lack of essential nutrients can lead to skin problems, including nummular eczema.
20. Age: Older people are more prone to nummular eczema due to thinner, drier skin.
21. Genetics: Some people may be genetically predisposed to nummular eczema.
22. Immunodeficiency: People with weakened immune systems are more susceptible to skin conditions, including nummular eczema.
23. Physical Trauma: Cuts, burns, or abrasions can trigger nummular eczema in some people.
24. Contact with Chemicals: Exposure to certain chemicals can lead to nummular eczema outbreaks.
25. Varicose Veins: People with varicose veins are more prone to nummular eczema.
26. Occupational Hazards: Jobs that require handling certain chemicals or materials can increase your risk of nummular eczema.
27. Exposure to Water: Regular contact with water can dry out your skin and increase your risk of nummular eczema.
28. Sun Exposure: Overexposure to the sun can dry your skin and lead to nummular eczema.
29. Certain Skin Treatments: Overuse of certain skin treatments can damage your skin and trigger eczema.
30. Lack of Sleep: Not getting enough sleep can weaken your immune system and make you more prone to nummular eczema.

Symptoms

Symptoms associated with nummular eczema, all in easy-to-understand language.

1. Round or Oval Patches: The most recognizable symptom of nummular eczema is the formation of round or oval patches on the skin. These patches are coin-shaped and hence the name ‘nummular,’ which means ‘coin’ in Latin.
2. Itchy Skin: These patches tend to be very itchy, causing discomfort, especially during flare-ups. The intensity of the itch can vary from mild to severe.
3. Redness: The affected skin areas often appear red and inflamed, indicating a reaction going on underneath your skin.
4. Dry and Scaly Skin: The skin around these patches may become extremely dry and start to scale. It may feel rough to touch and look cracked or flaky.
5. Burning Sensation: In some cases, nummular eczema may cause a stinging or burning sensation, adding to the discomfort.
6. Lesions or Blisters: Some people might experience weeping lesions or blisters that can ooze fluid, usually in severe conditions.
7. Infection Signs: Because of the constant itching and scratching, the skin may get broken, leading to potential infections. Signs include pus, pain, or increased redness and heat around the area.
8. Color Changes: Over time, the eczema-affected skin might change color, becoming darker or lighter than the surrounding skin.
9. Size Variation of Patches: The patches can be of different sizes, ranging from a few millimeters to several centimeters in diameter.
10. Swelling: There can be swelling around the affected area, especially if the eczema is inflamed or infected.
11. Peeling Skin: The skin might start to peel off from the patches as they heal, leaving behind raw skin.
12. Bumpy Texture: The skin’s texture can change, becoming rough and bumpy, due to constant itching and inflammation.
13. Sensitive Skin: The affected areas may become extremely sensitive, responding severely to substances that would not normally cause a reaction.
14. Frequent Flare-ups: Nummular eczema is characterized by periods of flare-ups and remission. Symptoms may disappear for a while and then return suddenly.
15. Location-specific Patches: These patches often appear on specific body parts, such as the legs, hands, feet, and torso.
16. Poor Wound Healing: Wounds or scratches on the skin may take longer to heal in people suffering from nummular eczema.
17. Sleep Disruption: The discomfort and itchiness can often disrupt sleep, leading to daytime fatigue or tiredness.
18. Psychological Impact: Chronic conditions like nummular eczema can cause stress, anxiety, or depression due to ongoing discomfort and appearance-related concerns.
19. Cracks in the Skin: Over time, severe dryness can lead to deep, painful cracks in the skin.
20. Temperature Sensitivity: The affected skin areas might become more sensitive to temperature changes, causing discomfort during cold or hot weather.

Diagnosis

Diagnostic methods and tests that doctors use to identify and manage this condition.

1. Medical History Review: In the first instance, your doctor will take a detailed medical history. This includes discussing your symptoms, potential triggers, family history of skin conditions, and overall health.
2. Physical Examination: A physical exam allows your doctor to visually inspect the unique, coin-shaped rashes characteristic of nummular eczema.
3. Dermoscopy: This is a non-invasive procedure that employs a dermatoscopy – a device that illuminates and magnifies skin structures – to better view the rash.
4. Patch Testing: If the doctor suspects that allergies might be triggering eczema, they may conduct a patch test. This involves applying small amounts of allergens to your skin using tiny patches, which are then observed for reactions.
5. Skin Scraping and Microscopy: A small scraping of skin may be taken to observe under a microscope. This helps rule out fungal infections that mimic nummular eczema.
6. Skin Biopsy: In rare cases, a small skin sample might be taken for detailed laboratory analysis. This is done to confirm the diagnosis or exclude other conditions.
7. Complete Blood Count (CBC): This blood test provides information about your overall health, highlighting any underlying conditions that might be affecting your skin health.
8. Allergy Blood Testing: Specific blood tests can identify potential allergies, which might contribute to nummular eczema.
9. IgE Level Test: The level of Immunoglobulin E (IgE) in your blood can indicate an allergic response, which can be a trigger for nummular eczema.
10. Culture of Skin Scrapings: This test helps rule out bacterial or fungal infections, which can mimic or worsen eczema.
11. Asthma Assessment: As asthma is often seen in people with eczema, your doctor may assess your respiratory health.
12. Food Allergy Testing: If food allergies are suspected as a trigger, specific tests might be done.
13. Environmental Allergy Assessment: Testing for reactions to substances like dust mites, pollens, or pet dander can help manage triggers.
14. Dermatopathology Examination: This involves examining skin tissue at a microscopic level to identify or confirm skin conditions.
15. Patch Test Reading: A follow-up visit will be scheduled to read the results of your patch test, typically 48 hours and again at 72 or 96 hours after the test.
16. Intradermal Skin Testing: This is another type of allergy test where a small amount of allergen is injected under the skin.
17. Prick Testing: Yet another type of allergy test, where a small prick is made on the skin, and an allergen is introduced to observe for reactions.
18. Radioallergosorbent Test (RAST): This blood test helps identify specific allergen sensitivity.
19. Eczema Area and Severity Index (EASI): This is a tool doctors use to measure the severity of eczema.
20. Scoring Atopic Dermatitis (SCORAD) Index: Another tool to assess eczema severity.
21. Investigation of Contact Materials: This involves assessing any materials you frequently come into contact with to identify potential triggers.
22. Evaluation of Personal Care Products: Your doctor may analyze the personal care products you use to determine if they could be causing or worsening your eczema.
23. Pulse CO-Oximetry Testing: This test assesses your oxygen level in the blood, as chronic skin conditions can sometimes affect oxygen levels.
24. Dietary Assessment: The doctor may evaluate your diet to determine if any foods might be triggering your eczema.
25. Sleep Assessment: As poor sleep can worsen eczema, your doctor might assess your sleep patterns.
26. Stress Assessment: Chronic stress can exacerbate eczema, so your doctor may use various methods to evaluate your stress levels.
27. Dry Skin Care Education: A vital part of managing nummular eczema involves educating you on proper skin care techniques to prevent dryness and irritation.
28. Counseling on Avoidance of Triggers: Doctors will provide you with personalized advice on avoiding known triggers, thus managing your eczema effectively.
29. Treatment Monitoring: The doctor will monitor your response to treatment, adjusting it as needed.
30. Follow-Up Appointments: Regular follow-ups are essential to ensure that the treatment plan is working and to make necessary adjustments.

Treatment

Effective Treatments for Nummular Eczema – An Easy Guide

1. Moisturizers: Keeping skin hydrated reduces dryness, itching, and inflammation. Always choose fragrance-free to avoid irritation.
2. Topical Corticosteroids: These creams reduce inflammation. Use as directed by your healthcare provider.
3. Calcineurin Inhibitors: Prescription creams like tacrolimus or pimecrolimus are alternatives to corticosteroids. They work by suppressing immune response causing inflammation.
4. Crisaborole (Eucrisa): A newer treatment that tackles inflammation differently from corticosteroids and calcineurin inhibitors. It’s often used for mild to moderate eczema.
5. Coal Tar: An old but effective method, coal tar soothes itching and inflammation. It’s a bit smelly and messy though.
6. Antihistamines: Allergy pills like Benadryl can reduce itching, especially at night.
7. Antibiotics: If your nummular eczema gets infected, you’ll need these. Always finish your course.
8. Phototherapy (Light Therapy): UV light can reduce skin inflammation. It requires special equipment and trained providers.
9. Wet Wrap Therapy: Moistened bandages wrapped around the affected skin can soothe and heal stubborn eczema patches.
10. Oral Steroids: In severe cases, your doctor might prescribe these. They’re powerful but can have side effects.
11. Bleach Baths: Sounds scary, but it’s just a small amount of bleach in bathwater. It can kill bacteria and reduce inflammation.
12. Dupilumab (Dupixent): This is a newer injection treatment for moderate to severe eczema that targets specific proteins causing inflammation.
13. Topical PDE4 Inhibitors: Another newer class of drugs. These creams, like crisaborole, inhibit an enzyme involved in inflammation.
14. Oatmeal Baths: Soothing and natural, oatmeal can calm inflamed skin.
15. Probiotics: Certain strains can boost your immune system and potentially help manage eczema.
16. Omega-3 Fatty Acids: Found in fish and flaxseeds, they can help reduce inflammation.
17. Vitamin D: Some research suggests it could help manage eczema, but check with your doctor before starting supplements.
18. Vitamin E: It’s good for skin health. You can apply it directly or take it orally.
19. Evening Primrose Oil: Some studies suggest this could help reduce eczema inflammation.
20. Coconut Oil: It’s hydrating and has antibacterial properties, making it a good natural option.
21. Hypnotherapy: This can help manage stress, a known eczema trigger.
22. Acupuncture and Acupressure: Traditional Chinese methods that some people find helpful.
23. Homeopathy: A holistic approach that uses very small doses of natural substances to stimulate the body’s healing response.
24. Yoga and Meditation: Stress can trigger or worsen eczema. Relaxation techniques like yoga and meditation can help manage stress levels.
25. Elimination Diet: Some food allergies can trigger eczema. Work with a dietitian to see if this applies to you.
26. Allergy Testing: Knowing your triggers can help you avoid them. This could include environmental allergies like dust mites or pollen.
27. Humidifiers: These can help if dry air aggravates your eczema.
28. Cool Compresses: Placing these on affected areas can soothe itching and inflammation.
29. Cotton Clothing: Breathable fabrics like cotton can help prevent overheating and irritation.
30. Regular Doctor Visits: Eczema is a chronic condition. Regular check-ins with your healthcare provider can help manage symptoms effectively.

In summary, treating nummular eczema involves a combination of medications, lifestyle changes, and natural remedies. However, what works best can vary from person to person. Always consult a healthcare provider before starting any new treatment regimen.

References