Nummular eczema is a chronic condition that produces coin-shaped spots on the skin. There is no cure for it but you can manage your condition by making lifestyle changes.
Our dermatology residents used to refer charity patients to me from the OPD and this boy was no exception. He was probably 20 years old and when I first met him, he was covered with clusters of tiny fluid-filled rashes all over his body. The rashes were so itchy he could not sleep or work.
At that time, he was so desperate because he was the only child of an aging parent who looked up to him as a potential sole breadwinner. But due to his skin condition, he could not get a decent job. He shared that he sometimes thought of committing suicide because of his skin problem.
I took pity on him and decided to treat him for free. I diagnosed him with severe nummular eczema and started treating him with medicines that usually cleared the rashes. But as we went along, I noted that his condition was quite different from all the other patients I handled before and this baffled me.
I gave him immunosuppressives, topical medicines, injections, etc., but his skin condition was unremitting. I changed his oral medications twice, but this didn’t seem to work so I decided to shift him again to a third one and this time, it worked!
So, for 15 long years, he was free of the eczema and I was very happy for him. He is now married with a kid. Then a few weeks ago, he had an accident while helping his neighbor construct a house. He accidentally fell off the galvanized roof, abrading his arms and thighs.
A few days after the accident, he again developed similar rashes as 15 years ago. At this point, what originally worked was no longer effective so I had to choose another treatment regimen which fortunately solved the problem after several weeks.
What is nummular eczema?
Nummular eczema, also known as nummular dermatitis or discoid eczema, is a chronic condition that produces coin-shaped spots on the skin. These spots are often well-defined and very itchy. They sometimes ooze with clear fluid, then dry up with crusty tops.
Sometimes, they appear after a skin injury such as a burn, abrasion, or insect bite, resulting in one or multiple patches of coin-shaped lesions. The patches can last for several months. They tend to occur more often in men than in women. Men usually have their first episode between ages 55 and 65. Women typically get it during adolescence or young adulthood. Though the symptoms of nummular eczema can be bothersome, they can be treated with medications and topical medicines. It is not contagious, which means it cannot be passed from one person to another through direct skin contact.
What triggers nummular eczema?
Nummular eczema is genetic. People with nummular eczema have a personal or family history of allergies, asthma or atopic dermatitis. Atopic dermatitis is a skin condition that causes itchy or scaly rashes. People with such eczema also tend to have sensitive skin that gets irritated easily.
The following factors may also contribute to the development of nummular eczema: temperature changes, stress, dry skin, environmental irritants such as soap, metal, and formaldehyde.
The following conditions may increase the risk of developing nummular eczema: living in a cold, dry climate, having dry skin, having poor blood flow or swelling in the legs, having another type of eczema, having a skin injury such as an insect bite or abrasion, having a bacterial infection that affects the skin.
How is nummular eczema treated?
There isn’t a cure for nummular eczema. However, you may be able to manage your condition by making certain lifestyle changes and avoiding triggers.
To help control your nummular eczema, you should avoid:
• wool and other irritants that may trigger your symptoms
• excessive bathing and hot water
• using harsh soaps
• stress
• exposure to environmental irritants such as household cleaners and chemicals
• using fabric softener and dryer sheets
• getting scrapes, cuts and abrasions on the skin
The following can help relieve your eczema:
• using moist bandages to cover and protect the affected areas
• taking antihistamines to relieve itching and discomfort
• applying medicated lotions or skin ointments
• getting ultraviolet light treatment for severe itching
• hydrating skin with a non-scented moisturizer after showering
What is the outlook for people with nummular eczema?
With the proper treatment, nummular eczema may improve within one year or less. However, nummular eczema is a chronic condition so it will never be resolved permanently. Lesions may go away completely while others may come and go. Lesions on the thighs, legs, and feet often take longer to heal and may leave behind darker or lighter spots. It’s best to avoid triggers that make your symptoms worse.
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