Nummular Eczema

Key Points
Type of dermatitis which most commonly affects the lower leg
Exact cause is unknown
Consists of round or oval brown, pink or red patches of skin which are dry and cracked or bumpy and blistered on their surface

Nummular eczema is a type of dermatitis which most commonly affects the lower leg. The condition consists of round or oval brown, pink or red patches of skin. The surface of these lesions may be dry and cracked, or may appear bumpy, blistered and crusted. In some cases, lesions are accompanied by severe itching. The condition may also become generalized, with lesions forming over large areas of the body. Hyper- and/or hypopigmentation may occur after lesions resolve.

The exact cause of nummular eczema is unknown, though it is often attributed to a combination of dry skin and immune system malfunction. Infants and children are sometimes effected and is fairly common in those in their 50's and beyond. Additionally, the condition is susceptible to secondary bacterial infection.

Differential Diagnosis (Other conditions with similar appearance)
Asteatotic Eczema
Lichen Simplex Chronicus
Atopic Dermatitis
Pityriasis rosea
Contact Dermatitis
Psoriasis, Plaque
Tinea Corporis
Cutaneous T-cell lymphoma

Diagnosis
Key Points
Diagnosis based on skin appearance
Patch testing or skin swabs may be performed in some cases to confirm diagnosis

Nummular eczema is generally diagnosed based on appearance. Patch testing or skin swabs of the affected area may be taken to confirm diagnosis.

Treatment
Maintenance of healthy skin is a key factor for affected persons
Goal of treatment is to control symptoms and prevent infection
In moderate and severe cases, those diagnosed may be prescribed medications to assist in alleviating symptoms

See our dry skin and eczema patient handout for recommendations.

OTC Options: Non-soap Cleansers or moisturizing soaps, thick moisturizers

Self-care of nummular eczema is a key factor in its treatment. Maintaining a moisturizing regiment, including the use of non-soap cleansers or moisturizing soaps, the application of thick moisturizers such as petroleum jelly after bathing, and minimizing exposure to elements which may exacerbate the condition, such as heat, humidity, soaps/detergents, abrasive materials, smoke/chemicals, and stress, are recommended by health care professionals to alleviate symptoms and minimize recurrence.

In moderate and severe cases, health care professionals have several options for prescription treatments. Topical steroids can be used to treat affected areas, and oral antihistamines may be prescribed to reduce itching. If infection is present, topical or oral antibiotics may be used. Phototherapy may also be recommended. In severe cases, systemic steroids may be administered.