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Eczema types: Nummular eczema diagnosis and treatment


If you have itchy, raised spots or patches on your skin, making an appointment to see a board-certified dermatologist can be helpful. One possible cause is nummular eczema. Other skin conditions like ringworm and atopic dermatitis can also cause these signs and symptoms.

To get effective treatment, you need an accurate diagnosis.

The following explains how dermatologists diagnose and treat nummular eczema.

How do dermatologists diagnose nummular eczema?

When you have nummular eczema, a dermatologist can often diagnose you by examining the spots or patches on your skin.

Dermatologist examining spots on a patient’s hand

When diagnosing a skin condition, dermatologists rely on their in-depth knowledge of the skin and tools that magnify their view.

Dermatologist using dermatoscope to examine patient’s hand

If your skin shows signs of infection, your dermatologist will swab that spot.

Your dermatologist may also perform a skin biopsy. This involves removing a bit of the affected skin to test it for a condition. Your dermatologist can perform a skin biopsy during your office visit.

If you have nummular eczema, your dermatologist will create a treatment plan tailored to your needs.

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.

Woman adding bath oil to a bathtub of water

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.

Treat the spots and patches on your skin: To help clear the eczema, your dermatologist will prescribe medication or light treatments. Most people will apply one of these medications:

  • Corticosteroid ointment

  • Tacrolimus ointment or pimecrolimus cream

  • Tar cream

All of these medications can reduce the inflammation and itch.

For best results, you may need to apply your medication to damp skin immediately after bathing. This can help the medication heal your skin more quickly.

If you have widespread spots and patches, you may need stronger treatment. Your dermatologist may prescribe medicated dressings that you will apply or a corticosteroid medication that you take. Some patients receive an injection of corticosteroids.

For some people, a light treatment called phototherapy may be an option. To receive light treatments, you will need to go to a phototherapy treatment center or hospital a few times a week for several weeks.

Get rid of infection: If you developed an infection, your dermatologist will prescribe medication to help clear the infection. You may need to apply this medication directly to your skin or take pills.

Help you sleep: If the itch keeps you awake, your dermatologist may recommend taking an antihistamine that makes you drowsy. Being well-rested can help your skin to heal. Once the eczema starts to clear, the itch tends to go away.

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.

It’s 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.


Images
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References
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.

Krupa Shankar DS, Shrestha S. “Relevance of patch testing in patients with nummular dermatitis.” Indian J Dermatol Venereol Leprol. 2005;71(6):406-8.

Leung AKC, Lam JM, et al. “Nummular eczema: An updated review.” Recent Pat Inflamm Allergy Drug Discov. 2020 Aug 10. [online ahead of print].

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.

Reider N, Fritsch PO. “Other eczematour erupution.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018:233-4.

Trayes KP, Savage K, et al. “Annular lesions: Diagnosis and treatment. Am Fam Physician. 2018 Sep 1;98(5):283-91.


Written by:
Paula Ludmann, MS

Reviewed by:
Erin Ducharme, MD, FAAD
Amanda Friedrichs, MD, FAAD

Last updated: 3/15/21

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