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Most nummular dermatitis cases should respond to conservative measures such as gentle skincare and bland emollients used in combination with mid- to high-potency steroids. Consultation with a dermatologist should be considered in refractory, widespread, or atypical cases. Further evaluation may include skin scraping with potassium hydroxide preparation, bacterial swab for culture and sensitivities, biopsy, or patch testing, as discussed previously. If narrow-band UVB light therapy, systemic immunosuppressant, or immunomodulator is warranted, this should also be carried out under a dermatologist's supervision.
Treatment of nummular dermatitis can be optimized with an interprofessional team approach. The patient’s nurse, primary care provider, or dermatologist should monitor for therapy compliance, report any adverse effects, and relay the response to therapy to the remainder of the team. This interprofessional teamwork will enhance patient outcomes and minimize adverse reactions in caring for patients with nummular dermatitis.
The management of nummular dermatitis focuses on restoring the natural skin barrier and avoiding behaviors that dry and irritate the skin.[14]
General Measures
Topical Therapies
High- or ultrahigh potency (classes I-III) topical corticosteroids applied directly to affected skin 1 to 2 times daily help decrease inflammation and pruritus. Topical calcineurin inhibitors (tacrolimus, pimecrolimus) may be used as steroid-sparing topical agents. A typical alternating schedule includes topical corticosteroids on weekdays and topical calcineurin inhibitors on weekends. For isolated recalcitrant lesions, intralesional triamcinolone may be a treatment option (0.5-1 mL of 4-5 mg/mL triamcinolone per lesion).
Phototherapy
For widespread disease in which topical treatment may not be feasible, narrowband UVB light therapy should be considered. Light therapy should be administered 2 to 3 times weekly, slowly titrating to the appropriate duration and desired clinical response. The therapy should be discontinued if a response is not noted after 30 treatments. In patients who respond, the frequency should be reduced to once weekly for a month, then to every other week for 2 months, as needed and tolerated. For all patients undergoing phototherapy, the potential increased risk of skin cancer should be weighed against the benefits of avoiding the use of systemic immunosuppressants in the individual patient.
Systemic Therapies
If light therapy is not available, systemic immunosuppressants and immunomodulators have been used to treat extensive recalcitrant disease, including:
Systemic corticosteroids: Oral prednisone can be initiated at 40 mg per day, with the dose reduced by 10 mg every 5 days before being discontinued. Alternatively, intramuscular triamcinolone at a dose of 40 mg can be given up to once every 3 months.
Methotrexate: A dose of 10 to 15 mg per week is an alternative therapy for patients for whom systemic corticosteroids are contraindicated or for whom the disease recurs shortly after corticosteroid discontinuation.[16]
This type of eczema most commonly develops during these ages:
Children rarely develop nummular eczema. A few children living with severe atopic dermatitis (AD) have developed nummular eczema. Skin with severe AD can be excessively dry, even in children. This may play a role in causing nummular eczema in children.
Certain pre-existing diseases may also increase the risk of developing nummular eczema. Researchers found that patients were more likely to develop nummular eczema if they had one of the following:
While studying nummular eczema, researchers also discovered another key finding: Nummular eczema rarely clears without treatment.
It can take time to find an effective treatment. Because dermatologists specialize in treating skin disease, seeing a board-certified dermatologist can be a big help. Board-certified dermatologists run many of the studies for this disease and stay up to date on the latest research.
To find out how dermatologists diagnose and treat this type of eczema, go to: Nummular eczema: Treatment.
Image
Used with permission of DermNZ
Choi S, Zhu GA, et al. “Research letters: Dupilumab treatment of nummular dermatitis: A retrospective cohort study.” J Am Acad Dermatol. 2020,82(5):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(1):36-42.
Lugović-Mihić L, Bukvić I, et al. “Factors contributing to the chronic urticaria/angioedema and nummular eczema resolution – Which factors are crucial?” Acta Clin Croat. 2019,58(4):595-603.
Miller JL, “Nummular dermatitis (nummular eczema).” In James WD [editor]. 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(3-4):75-87.
The main goals of treatment are to clear your skin and ease your discomfort. To do this, your treatment plan may include treatment designed to:
Hydrate your skin: It’s likely that you have extremely dry skin. To add moisture to your skin, which will help heal your skin, you may need to:
Moisturizer plays a key role in healing your skin. Your dermatologist may recommend a hypoallergenic, fragrance-free moisturizing cream or ointment instead of a lotion. Creams and ointments do a better job of trapping water in your skin than do lotions. Having more water in your skin can help you heal faster.
Some bath oils can irritate your skin, which can worsen nummular eczema.
Avoid irritating your sensitive skin: Dry, sensitive skin is more likely to have frequent flare-ups of nummular eczema. For this reason, your treatment plan may include instructions that can help you avoid irritating your skin.
You may need to: