nummular (discoid) eczema; exudative dermatitis
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Epidemiology
- two peaks of incidence: young adults & old age
- most common in fall & winter
- especially common in elderly men during the winter
- common in individuals with a history of atopic dermatitis
Pathology
- subacute inflammation with acanthosis & spongiosis
Clinical manifestations
- chronic pruritic inflammatory dermatitis
- pruritus* may be extreme
- coin-shaped lesions
- excoriations may occur secondary to scratching
- regional clusters of lesions or generalized distribution
- predilection* for:
- lower legs (older men)
- fingers (younger female)
- on trunk & extremities of patients with dry skin[4]
* images[3]
* claim that lesions are NOT pruritic; MKSAP17 & 19 state they are pruritic[2]
* claim that lesions are NOT vesicular
* coin-shaped jewelry can produce coin-shaped lesions of contact dermatitis due to nickel with predilection for wrists & neck where jewelry is worn
Laboratory
Differential diagnosis
- epidermal dermatophytosis
- allergic contact dermatitis
- coin-shaped jewelry can produce coin-shaped lesions of contact dermatitis due to nickel with predilection for wrists & neck where jewelry is worn
- psoriasis
- early stages of mycosis fungoides
- impetigo
- familial pemphigus
Management
- chronic disorder, often difficult to manage
- skin hydration
- topical glucocorticoids 1st line[4]
- intralesional triamcinolone 3 mg/mL
- crude coal tar 2%; may be combined with corticosteroid preparations
- systemic antibiotics if Staphylococcus aureus is present
- PUVA is effective, but recurrences do occur
More general terms
References
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 68-69
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2022
- ↑ 3.0 3.1 DermNet NZ. Discoid eczema. (images) http://www.dermnetnz.org/dermatitis/nummular-dermatitis.html
- ↑ 4.0 4.1 4.2 NEJM Knowledge+ Dermatology
Leung AKC, Lam JM, Leong KF, Leung AAM, Wong AHC, Hon KL. Nummular Eczema: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(2):146-155. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32778043 Review.