Alles wat u moet weten over nummulair eczeem - Symptomen, oorzaken en behandelingen

How Is Nummular Eczema Treated?

There is no cure for nummular eczema, but there are several ways to effectively manage the condition.

Skincare

Skin dryness is one of the major factors that contribute to exacerbations. Keeping the skin well moisturized strengthens the barrier protection and reduces the risk of flare-ups.

Here are some tips that can help:

• Apply moisturizer every day year-round. Apply to damp skin after every bath or shower, and every time you wash your hands. You should also do so whenever your skin feels dry.
• Use a fragrance-free, hypoallergenic cream or ointment, Avoid thick lotions that can block evaporation and trigger sweating.
• Shower or bathe for no longer than 20 minutes. Anything longer can oversaturate the skin and actually pull moisture out of the skin, leading to dryness.
• Use lukewarm rather than hot water for bathing or showering. Overheating the skin can also lead to moisture loss and skin dryness.
• Use mild, fragrance-free, and hypoallergenic skin care products. This includes soaps, cleansers, and wipes. Avoid overusing alcohol-based sanitizers that dry skin.
• Use a humidifier to increase air moisture. Both air conditioners and heaters can pull moisture out of the air and cause skin dryness.
• Prepare for extreme temperatures. Keep indoors as much as possible during summer heatwaves or hard freezes in winter. If you can't, try wearing moisture-wicking fabrics when in hot temperatures and light thermal underwear when in extreme cold.

Steroid Medications

Topical corticosteroids (steroids) are the first-line drug treatment for nummular eczema. Most cases respond well to intermediate- to high-potency steroids, often bringing flare-ups under control within one to four weeks.

Topical steroids are generally applied to affected skin two to four times daily. Ointments are often preferred over gels as they have emollients that help moisturize the skin.

Consultations

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.

How do dermatologists treat nummular eczema?

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:

• Take a daily bath or shower up to 20 minutes long in lukewarm water.
• Add bath oil to your daily bath. Bath oil can make your bathtub and skin slippery. Use caution when adding bath oil to a bath so that you do not fall.
• Apply moisturizer as instructed throughout the day, which includes applying it to damp skin within minutes of bathing.
• Use a humidifier in your bedroom, and keep the room cool and moist.

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.

If your treatment plan includes bath oil, only use the bath oil recommended by your dermatologist

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:

• Use only a mild, non-drying cleanser to wash your skin, applying it only to skin that needs washing, like the armpits, feet, and groin.
• Wear loose-fitting cotton clothing.
• Avoid sitting next to a fireplace, heater, or other source of heat.
• Use a humidifier in your bedroom so that you can rest in a cool, moist place.

History and Physical

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]