An Overview of Nummular Eczema

Nummular Eczema

Lester V. Bergman / Getty Images

In This Article

Table of Contents

Nummular eczema is a type of eczema rash that is coin-shaped. The word "nummular” means coin in Latin. When nummular eczema happens, there is usually a disruption in the skin barrier which allows allergens through the skin. This may cause the itchy, red, disc-shaped rash. Atopic dermatitis, another type and the most common form of eczema, is usually related to being allergic to various things while nummular eczema is generally associated with contact dermatitis.

Symptoms 

Nummular eczema appears as round, disc-like lesions and can appear anywhere on the body. It is most likely found on the arms and legs.

The lesions can be very itchy, while some people say the lesions are only itchy when they are just developing. There may be crusting over the lesion and the rash can have liquid drainage. The skin around the lesions may be red.

Nummular eczema can cause pain and can also be the cause of emotional stress because of its appearance. But many patients are able to get help from their physician.

Causes

Different conditions may cause or aggravate nummular eczema. These include:

  • Dry skin
  • Contact dermatitis
  • Weather
  • Emotional stress (stress may make you feel itchier)
  • Oral medications including interferon (usually used to treat hepatitis) or isotretinoin (a popular acne medication)
  • Topical medications including topical antibiotic creams like Neosporin
  • Previous skin damage including a burn or other wound, open skin from scratching, or insect bite

Unlike other forms of eczema, nummular eczema does not generally affect children but rather appears for the first time in adulthood.

It is more likely to affect men who are between the ages of 55 and 65. Women generally experience their initial nummular eczema episode between the ages of 13 and 25.

Diagnosis

Accurate diagnosis of nummular eczema can be difficult as the rash may appear different on different skin types. So your doctor will likely ask you a lot of questions.

Skin Biopsy

Your doctor may need to rule out other skin diseases that resemble nummular eczema. This is done with a skin biopsy.

The biopsy sounds scary, but the test is performed with local anesthesia and most patients say it is not too bad. The biopsy allows a pathologist to examine the skin under a microscope to help determine the cause of the rash.

Patch Test

A patch test to look for contact dermatitis may also be beneficial for patients with nummular eczema. The patch test helps in diagnosing if any personal products or other agents that you are exposed to could be worsening your rash. The most common culprit is nickel, but fragrances, rubber products, and others can be the cause as well.

The patch test is a three-day test that is placed on your back. It is important not to get your back wet with water or sweat as it can interfere with the patches and then provide inaccurate results.

On the last day of your test, the physician will read your patch test and give you a list of what you are allergic to. It is exciting to have a positive test because it means you can actually avoid products that are worsening your eczema.

Differential Diagnoses

The most common diagnosis nummular eczema gets confused with is a fungal skin infection. A fungal infection can also be itchy which adds to the confusion between the two diagnoses.

The treatment for the different rashes differs greatly, so it is important to see a physician for the correct diagnosis.

Treatment

Nummular eczema is considered a chronic condition that cycles between flares and quiescence.

It is important to keep skin hydrated and avoid exacerbating factors which may include allergens found on your patch test, and manage stress.

In addition, there are several topical medications that can help treat this skin condition.

Steroid Medications

The best treatment for nummular eczema is topical steroids. Generally, a strong topical steroid (rather than a milder form) is needed to help resolve the rash.

Topical steroids have important side effects including:

  • Hyper or hypopigmentation of skin, meaning your skin color becomes lighter or darker
  • Telangiectasias (enlarged blood vessels, usually capillaries)
  • Skin atrophy (skin thinning)
  • Easy bruising
  • Increased risk of skin infection

Typically, you will only experience these side effects if you use topical steroids for a prolonged period of time or on an injured skin surface.

Your physician may ask you to be extra cautious in areas like the face, neck, underarms (axilla) and groin area, as skin is thinner in these areas and is more likely to suffer from the adverse effects listed above. Make sure you and your doctor are monitoring your steroid use.

Oral steroids may also be helpful if the rash is worse than usual. Oral steroids are not usually the best treatment option because it can worsen dermatitis after the steroid taper.

Non-Steroid Medications

Other topical agents including Protopic (tacrolimus) or Elidel (pimecrolimus) work on a different pathway and can also help with nummular eczema. These agents are not steroids, so they carry much less adverse effects but may not be as helpful as the first-line therapy which is topical steroids.

It is important to note that these topical creams can cause burning after application.

Eucrisa (crisaborole) is a new topical medication that is also not a steroid and may be helpful in those that are unable to use topical steroids.

Antihistamines are another great class of medications to help with nummular eczema. Antihistamines may include Cetirizine, Fexofenadine, Levocetirizine, and Loratadine. Some of these medications can be taken more than once a day to relieve the annoying itch.

Treating Infection

Nummular eczema can look a little worse if there is concurrent infection overlying the rash. Usually, the most common organism found in culture is Staphylococcus aureus. If found, it will require additional treatment, most likely with an oral antibiotic.

Let your doctor know if you develop a fever or chills as these symptoms may indicate an infection.

Coping

One of the most difficult things to deal with during a flare of nummular eczema is the itching. This condition can be intensely itchy, to the point of interfering with your daily activities and your ability to sleep.

Keep the skin hydrated. Apply a thick layer of a fragrance-free, hypoallergenic cream or ointment as often as needed. This helps with the dryness associated with this skin condition and, in turn, can help soothe the itch. There are many over-the-counter creams that fit the bill. Ask your doctor or pharmacist for recommendations.

Use wet wraps or ice packs. These can be placed over any itchy areas of the skin. Wet wraps can be left on overnight if needed. If you're using icepacks, make sure you're placing a cloth between your skin and the ice.

Keep your skin covered while you sleep. Wear long pajamas, ideally made from a soft fabric, or cover the rash loosely with a bandage. This can help prevent you from scratching at the rash while you sleep and causing damage to the skin.

If itching is unbearable, talk to your doctor about other ways to cope.

Manage Stress

Stress seems to be a big trigger for nummular eczema flares. Besides, the condition itself can cause stress thanks to the itching, discomfort, and embarrassment it can cause. Stress management helps you feel better and can help your skin too.

Take time for self-care. This includes getting enough sleep and exercise, drinking plenty of water, and eating healthy foods. Taking care of yourself physically makes you feel better all around.

Engage in stress-relieving activities. Anything that makes you feel happy, healthy, and contented, make time to do more of it. This can include yoga, reading, gardening, sports, or meditation.

Talk to your physician about your mental health. If you are struggling with anxiety, overwhelming stress, or depression, let your physician know. There are medications and lifestyle changes that can help.

Finding Support

It's also common for people with nummular eczema to feel self-conscious or embarrassed of the rash. You may feel like others are staring at your skin, are judging you, or avoiding you because they think it may be contagious. This alone can make you feel stressed and discouraged.

Finding support is key, especially if your nummular eczema is severe or long-lasting, as these can take a toll on your mental well-being.

Talking to trusted people in your life can help. Also, you may wish to reach out to others who know what you're going through.

Online support can be found through the National Eczema Association. If you live in a larger metropolitan area, you may also be able to find a local support group. Ask your doctor for recommendations.

A Word From Verywell

Nummular eczema can be a frustrating condition to deal with. With the right combination of treatment and home care, though, it can be brought under reasonable control. For some people, the skin may be cleared altogether. Talk to your doctor in order to get help and support.

Was this page helpful?

Article Sources