How Is Nummular Eczema Treated
Nummular eczema can look like psoriasis, ringworm, fungal infection and other types of eczema, including atopic dermatitis, stasis dermatitis and contact dermatitis. It can also occur along with those types of eczema, though it often appears as an isolated condition. Dermatologists can usually spot the condition but may take a skin scraping to confirm a diagnosis.
Once correctly diagnosed, nummular eczema tends to disappear completely with the right treatment. However, unlike some other forms of eczema, nummular seldom improves without relatively aggressive treatment.
Like atopic dermatitis, patches of nummular eczema are often infected with Staphylococcus aureus , which needs to be treated along with the skin inflammation to clear the condition.
Nummular eczema can be treated with a mid- or high-potency topical corticosteroid, along with a topical antibiotic. If eczema patches are substantially weepy and oozy, application of an astringent compress can help dry the area and drive out any staph infection.
For Best Results: Keep All Your Dermatology Appointments
Once treatment starts to work, your dermatologist may change your treatment plan. This helps to reduce possible side effects from medications while helping your skin clear.
Sometimes, treatment fails to work. If this happens, keep your dermatology appointment. You may need a different medication.
Its also possible that an allergic reaction is triggering the nummular eczema.
If your dermatologist suspects that you have an undiagnosed allergy, your dermatologist may recommend patch testing.
Patch testing can be extremely helpful for people who continue to have flare-ups of nummular eczema.
Researchers have found that when nummular eczema fails to go away, the reason is often an allergy. In studies, between 33% and 50% of patients with nummular eczema that failed to get better with treatment had an allergy. Finding and treating an allergy helps some people get rid of nummular eczema.
With proper treatment, nummular eczema can clear completely. Self-care also plays an important role. See what dermatologists recommend by going to: Nummular eczema: Self-care.
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ReferencesChoi S, Zhu GA, et al. Research letters: Dupilumab treatment of nummular dermatitis: A retrospective cohort study. J Am Acad Dermatol 2020 82:1252-5.
Jiamton S, Tangjaturonrusamee C, et al. Clinical features and aggravating factors in nummular eczema in Thais. Asian Pac J Allergy Immunol. 2013 31:36-42.
Miller JL, Nummular dermatitis . In James WD . Medscape. Last updated November 2020.
Even Bathing Is Complicated When You Have Eczema
Bathing in eczema patients can be quite an art form. Many of us may not realize that good bathing takes more than a tub of water and soap, and does far more than rinsing off dirt, grease and body odor.
Daily bathing rinses off substances such as irritants, allergens and germs that may flare eczema. That said, water and soap strips the natural oil that coats our skin surface and can make us more prone to eczema flares. Therefore, bathing for 10 minutes or less daily with lukewarm water and a limited amount of gentle soap is recommended.
There is ample research demonstrating that what lies in our bathwater can both benefit and harm eczema skin. A recent study found that bathing with hard water can increase skin deposition of an irritating chemical that is commonly found in soaps, further irritating eczema skin.
It would make sense that installing water-softening machines might minimize the negative effects of hard water on eczema skin, but available research has not been able to prove this.
Several additives in bathwater can improve eczema. The most well-known and widely used bathing additive is bleach. The recommendation by the American Academy of Dermatology is to add a half cup of regular strength bleach to a full tub of water, or one teaspoon of bleach per gallon of water for babies.
It also appears that bleach may improve eczema by alternative mechanisms, such as directly decreasing itch sensation and skin inflammation.
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Fatty Acids: Evening Primrose Borage Oil
Gamma linoleic acid , a polyunsaturated fatty acid, is a precursor of inflammatory mediators such as prostaglandin E and is the primary substrate for arachidonic acid . It has been suggested that the enzyme responsible for converting linoleic acid to GLA may be deficient in in patients with AD . Evening primrose oil , black currant seed oil , and borage oil contain relatively high levels of GLA and therefore have been an area of investigation in the realm of supplemental management in AD.
A small RCT evaluated EPO supplementation in children and adults with AD and reported reduced itching and intensity of symptoms when compared to placebo . In another RCT, 313 pregnant mothers with strong atopic history were supplemented with BCSO or olive oil as placebo starting at 816 weeks’ gestation and continuing throughout the duration of breastfeeding. Infants born to these mothers in the BSCO group were found to develop lower than expected prevalence of AD in the BSCO group at 12 months of age as well as lower SCORAD indices in those infants affected. However, no differences were seen between groups at 24 months . A 2013 Cochrane review, assessing the effects of EPO or BO on treating symptoms of AD, failed to show benefit from either oral fatty acid supplement when compared to placebo. The analysis included 27 studies and nearly 1600 participants .
If You Continue To Have Flare
Its common for nummular eczema to come and go. If you have spots and patches on your skin or the itch feels unbearable, a board-certified dermatologist can help.
ReferencesCenters for Disease Control and Prevention. Alcohol use and your health. Page last reviewed October 1, 2020. Last accessed December 11, 2020.
Jiamton S, Tangjaturonrusamee C, et al. Clinical features and aggravating factors in nummular eczema in Thais. Asian Pac J Allergy Immunol. 2013 31:36-42.
Leung AKC, Lam JM, et al. Nummular eczema: An updated review. Recent Pat Inflamm Allergy Drug Discov. 2020 Aug 10. .
Miller JL, Nummular dermatitis . In James WD . Medscape. Last updated November 2020.
Purnamawati S, Indrastuti N, et al. The role of moisturizers in addressing various kinds of dermatitis: A review. Clin Med Res. 2017 15:75-87.
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Symptoms Of Nummular Eczema Or Dermatitis
There are a variety of symptoms of discoid eczema , and they may come in waves.
You may first begin to notice a small group of red spots on the skin. These can appear anywhere, although they are unlikely to show up on the head or scalp. Eventually, they might form larger pink, red, or brown patches.
The size of the coin-shaped spots can vary from a few millimeters to several centimeters, and usually arise with swelling. As they swell, they may appear like blisters with small, fluid-filled pockets at the surface, which may ooze fluid.
Over time, the spots may become crusty, dry, cracked, or flaky, which is what leads to confusion about ringworm. The outer ring of the rash will remain red, brown, or purple while the inside portion will appear white or yellowish, or return to its original color.
The rash can also become quite itchy, and may intensify at night. This may be aided through the use of an antihistamine or doctor-prescribed corticosteroid cream.
Its highly recommended to avoid scratching the rash or popping the blister to avoid infection. The symptoms of an infected nummular eczema rash include:
- Oozing of excessive fluid
- Yellow crust forming atop the rash
- Hot, red, swollen, tender, or painful surrounding skin
- Nausea, fever, or chills
If youve never experienced this form of eczema before, seek treatment from your doctor or dermatologist.
Nummular Dermatitis: Symptoms Causes And Treatments
Nummular dermatitis also known as discoid eczema or nummular eczema is a chronic skin condition that causes itchy, swollen, and cracked patches of skin. The word nummular is derived from the Latin word for coin, as the circular or oval-shaped patches that form on the skin resemble the size and shape of a coin.
Nummular dermatitis often affects the limbs especially the legs although the rash may be generalized across the body. Without proper treatment, nummular dermatitis can persist for a long time, sometimes lasting for years. However, with the right treatment, people with nummular dermatitis can feel better within 10 days.
Nummular dermatitis is often a chronic condition, so it may never fully resolve. It may clear up completely in some people. For others, it keeps coming back, often in the same areas that were previously affected.
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Psychological And Educational Interventions
Stress can negatively impact the immune system via a number of proposed mechanisms . Massage, relaxation, biofeedback, hypnosis, and aromatherapy have been explored as complimentary approaches in treatment of AD. The majority of psychological and educational intervention studies use these techniques as adjuvant modalities in combination with conventional topical therapies.
Coping with stress through support groups and progressive muscle relaxation has shown to have a positive influence on patients quality of life, pruritus scores, and loss of sleep, but there is less evidence that it has an effect on eczema severity indices . Biofeedback and hypnosis were combined in one study and compared to a control group. In this study, the intervention group demonstrated significant reduction in an eczema severity score at 8 and 20 weeks .
Multidisciplinary structured educational programs for children with AD and their families have shown benefit in reducing eczema severity and improving quality of life measures . A recent Cochrane review evaluated 10 studies using educational interventions and psychological interventions as adjunct therapies to conventional treatment for children with AD. Although data was not sufficient for a comparable meta-analysis, the authors report that there is evidence to demonstrate benefit from structured educational and psychological interventions in terms of eczema severity and quality life for both children and families .
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Nummular Eczema Information.
Nummular eczema also know as nummular dermatitis is a skin disorder that is allergy triggered.
It breaks out in patches or spots shaped like coins on your skin, and itches like other forms of eczema. Similar to other types of eczema, a specific cause is hard to pinpoint.
Normally it is said to be allergies, asthma, or it can start off as another condition like the atopic form of eczema. This happens less often than the other types of eczema and older men get it more than women do.
Nummular eczema can be negatively affected by outside irritants, dry skin, fluctuations in temperatures, and stress.
Nummular Eczema Treatments.
Various treatments include staying away from the specific triggers, whether it be food allergies or any other thing that can stimulate a breakout or flare-up. Be careful of bathing frequently as this will make your skin dry out and can make Nummular eczema become worse.
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How Is Nummular Dermatitis Diagnosed
In many cases, nummular dermatitis can be diagnosed by its appearance. Skin swabs may be taken to test for infection with bacteria, such as Staphylococcus aureus. Scrapings may also be taken for evaluation. Fungal cultures may be used to rule out ringworm infection , which closely resembles nummular dermatitis with its ring-shaped appearance.
Your doctor will likely perform a differential diagnosis to rule out the possibility of other skin conditions that may resemble nummular dermatitis. These conditions, which include the following, may differ slightly from nummular dermatitis:
- Psoriasis These plaques are redder and scalier than those in nummular dermatitis and are symmetrically distributed.
- Tinea corporis Lesions are grouped with scaly or pustular edges.
- Lichen simplex Plaques are lichenified . This condition may coexist with nummular dermatitis.
- Contact dermatitis Lesions have an irregular shape and size.
- Stasis dermatitis This condition affects the lower legs and causes abnormal skin darkening resulting from leg swelling.
Patch testing may also be performed to rule out contact allergy to certain elements, such as chromate and nickel.
Where Does Nummular Eczema Occur
Nummular eczema was first described by Deverigie in 1857 as coin-shaped lesions on the upper extremities. Since then, it has been reported in all age groups and in all body areas but is most commonly found on the upper and lower extremities. Lesions usually start as papules, which coalesce into plaques.
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How Is Discoid Eczema Treated
A number of medications are available from your doctor to help treat discoid eczema, and there are also things you can do at home to make the skin more comfortable. See your GP for a diagnosis if you think that you may have discoid eczema, because other skin conditions such as psoriasis and ringworm can look very similar.
Reducing Redness On The Face
To get remove redness on the face, its helpful to have a daily skin care routine. Every day, wash your face with a gentle cleanser or water, pat the skin dry on the areas that are inflamed to soothe them, and then use a water-based moisturizer such as a cream or lotion to lock in moisture and reduce redness. This can really help to reduce inflammation fast!
Looking into your facial soaps, cleansers, and make-up products can help to see if there are harsh ingredients such as sulfates, exfoliants, or fragrance that might be causing your skin to break out.
Eczema on the face is typically patches of red and inflamed skin. This makes facial dermatitis especially difficult for children and adults to deal with, as it can be quite obvious and apparent!
Inflammation can also worsen due to outdoor triggers such as poor air quality such as pollution, dust, and dry weather. Because the skin has very little protection, its important to remove potential irritants and triggers.
In my video I show you what routine I do these days to keep my face clear and protected.
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Diagnosis And Medical Treatment Of Nummular Dermatitis
Due to the unique appearance of nummular dermatitis, a visual diagnosis can be made in most cases. If there is any doubt a physician may do a skin biopsy to rule out any other conditions.
There is no cure for nummular dermatitis, and in most cases the condition is chronic and persistent. The rash will typically go through phases of remission and flare-ups. Some patients clear the rash within a year, whereas others have recurring outbreaks for many years. The rash does tend to recur at the original site of infection.
Treatment of nummular dermatitis is centered around preventing future flare-ups, and when a flare-up does occur by treating the symptoms of the rash. Preventing flare-ups can be done through proper skin care and avoiding irritating conditions and substances. Here are some measures you can use to treat and prevent repeat flare-ups.
- Protect the skin from injury.
- Moisturizeapply lotion to the skin after bathing and a couple of times daily.
- Take cool to lukewarm showers .
- Avoid activities that cause excessive sweating and overheating.
- Avoid extremely hot and cold weather conditions.
- Use a humidifier in cold dry conditions.
- Avoid fabric softener and dryer sheets.
- Use mild soaps and detergents that are fragrance-free and dye-free.
- Wear loose-fitting cotton clothing.
- Avoid contact with harsh chemicals such as petroleum products, fertilizers, or gasoline.
How To Use Topical Corticosteroids
When using corticosteroids, apply the treatment accurately to the affected areas. Unless instructed otherwise by a doctor, follow the patient information leaflet that comes with the medicine.
Do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day.
To apply the topical corticosteroid, take the following steps:
Speak to your prescriber if you’ve been using a topical corticosteroid and your symptoms have not improved.
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What Do The Ecz
Once we identify nummular eczema and treat it appropriately, most people are significantly better within seven to 10 days, and, for patients who dont have another type of eczema, it often never comes back, according to Dr. Peter Lio, founding director of the Chicago Integrative Eczema Center. Even in those for whom this is a manifestation of their underlying atopic dermatitis, the nummular aspect seems to disappear quickly and then we can go back to overall management.
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Eczema Risk Factors Causes & Symptoms
As a matter of fact, there is a wide range of causes and risk factors associated with eczema. And, eczema symptoms can manifest widely differently between those affected. While a singular cause of eczema has not been established, there are certain common causes leading to the onset and flares. In addition, a wide range of risk factors has been identified.
Risk Factors for Eczema
- Temperature changes
Symptoms of Eczema
While many will experience a lessening of symptoms and fewer flares as they age, some will continue to experience eczema symptomsthroughout adulthood, such as atopic eczema rashes. Symptoms can range from mild to severe, and change from one outbreak to another. Common symptoms include:
- The appearance of small, raised bumps which may ooze liquid and develop a crust
- Thick, dry, scaly skin that cracks
- Red, brown or grayish patches of skin on hands, feet, ankles, wrists, neck, upper chest, eyelids, in skin folds, and on the face and scalp of infants
- Sensitive skin that is swollen and raw from scratching
- A recurring rash that causes intense itching, often disrupting sleep patterns
- Rashes due to atopic eczema
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