Nummular Dermatitis (Eczema)
Nummular Dermatitis (which is sometimes called “Eczema”) is a term that describes a constellation of findings that is quite variable (in appearance, age of onset, symptoms etc.) but is very common. It is one of the most frequently made diagnoses in all of dermatology.
Nummular Dermatitis can occur at any age, but it more frequently occurs in patients older than 40. Some patients tend to only get this during the colder months of the year. In those patients, it is sometimes referred to as “winter itch”. Several components are often present. These include coin shaped (“nummular”) areas of skin irritation that can be seen anywhere on the body but are commonly seen on the legs, arms, back and hands. These areas can be variable in size and are sometimes quite large. In many cases, these areas of dermatitis are itchy. The itching can sometimes be severe.
The cause of Nummular Dermatitis is uncertain in most cases. In some patients (but not all), it is related to dry skin. There does not seem to be any hereditary pattern. It can occur for seemingly no reason in a person who never had any problems with their skin before. In some patients, it comes during a certain time of year. It can also come for a while and then disappear without a trace. It is definitely not contagious. As you can see, this disorder can be very different from patient to patient. There are a number of treatment strategies for this problem, and your doctor/provider will design a plan for your individual case.
In most cases, your doctor/provider will prescribe a topical steroid medication (e.g. Topicort, Ultravate, Lidex, Triamcinalone, Halog, Sernivo, Elocon, or Temovate). This medicine is to be used as prescribed but generally is applied 2-3 times daily to the areas of dermatitis on an “as needed” basis. In other words, when the areas of dermatitis are under good control, you should taper back or stop the medication entirely. If the rash returns (which it sometimes does), go back to the medication in the previous manner and repeat the above. Overuse of the topical steroid can sometimes result in side effects to the skin or a phenomenon known as “tolerance” where the skin stops responding as well to the topical steroid.
If your case is particularly stubborn or itchy, your provider might also recommend a Kenalog shot or oral Prednisone. These medications are slightly stronger and can be quite beneficial to “jump start” your treatment. Side effects, though possible with any medication, are generally quite uncommon with these interventions.
One of the most important aspects of treating nummular dermatitis is to moisturize the skin consistently. This should be done REGULARLY even when the skin appears to be in good control. It is ideal to moisturize the skin in a more general manner (that is, to the arms, legs and trunk as a whole) instead of simply putting the moisturizer just on the areas of dermatitis/rash. The very best time to moisturize the skin is when the skin is damp such as after taking a shower/bath, but you can safely moisturize your skin anytime it is convenient for you. It is also OK to apply your medicated product (e.g. topical steroid) first to the skin and to then apply moisturizer right over the top of it. There are a number of very good skin moisturizers available. Some are prescription products such as Lachydrin, Salex, or Eletone. Over the counter (OTC) options are sometimes highly effective as well. These include Amlactin, Cetaphil, Eucerin, CeraVe, Moisturel, Aveeno, Neutrogena, or Gold Bond. Cetaphil Cream comes in a convenient 1 pound jar and is economical. You should generally try to avoid moisturizers with fragrances as fragrances are often irritating to skin. Actually, Plain Vaseline Petroleum Jelly works about as well as anything on the market, but it is very greasy which limits its use to some extent. For mild dermatitis and/or dry skin, a lotion based product might be sufficient, but cream based products tend to work better for more difficult cases of dry skin and dermatitis.
Some patients are prescribed oral medications to help with itching for this problem. These might include “over the counter” antihistamines such as Claritin
10mg, Zyrtec 10mg, Allegra 180 mg or generic equivalents. These specific antihistamines are not likely to cause excessive sleepiness. Other products such as
Hydroxyzine (Atarax), Benadryl or Doxepin may be utilized effectively as well. Those products are often taken at bedtime b/c they do sometimes cause drowsiness. Remember this if you are prescribed these latter medications b/c driving or concentration may be impacted.
On occasion, the skin can get superficially infected with bacteria in the setting of Nummular Dermatitis flares. As a result, your doctor/provider might give you a short course of antibiotics as part of your treatment course.
Some patients with Nummular Dermatitis respond well to other classes of topical products such as Protopic, or Elidel. These products, though sometimes highly effective, may prove to be more expensive than some of the other options. However, for certain patients, these products can be highly beneficial.
In resistant cases where itching and rash cannot be quickly controlled, other medications are sometimes employed. These include Azathioprine, Methotrexate,
Your doctor/provider will prescribe a regimen suited to your particular situation. If you do not respond well or if you have questions, please let us know as
we want you to have the best outcome possible!