Nummular eczema

Generality

Nummular eczema is a dermatitis, or an inflammatory disease of the skin, which causes very characteristic skin patches.

The precise causes have not yet been clarified, although they have been the subject of lengthy research.

For a precise diagnosis, an objective examination, an allergy test and various culture tests are required.

The therapeutic choice is wide, but identifying the most appropriate treatment is not always easy.

What is nummular eczema?

Nummular eczema or discoid eczema is an inflammatory disease of the skin, which causes the appearance of red-brownish oval or circular spots in various parts of the body. In particular, the areas most commonly affected are: forearms, hands, feet, trunk (chest, belly and back) and legs.

Nummular eczema is also known as nummular dermatitis .

DIFFERENT TYPES OF ECZEMI

Eczema and dermatitis are two synonyms, as they both refer to an inflammation of the skin.

In addition to nummular eczema, there are other types of eczema, for example:

• Atopic eczema, also known as atopic dermatitis . It is a skin inflammation whose origin is genetic and environmental components (exposure to allergenic substances, irritants). It affects most newborns and is often associated with asthma and hay fever.
• Contact eczema, more commonly called contact dermatitis . The inflammatory state of the skin occurs after contact with certain substances, which the body considers to be dangerous, even if they are not. It is, in fact, an allergic reaction.
• Varicose eczema . It is an inflammation of the skin that takes place in the legs of those who suffer from varicose veins.

Epidemiology

Nummular eczema can affect anyone and at any age, however it is much more common in male individuals aged between 50 and 70 years.

According to an Anglo-Saxon statistical study, nummular eczema would have an annual incidence of about 2 cases per 1, 000 people.

Its appearance is almost always associated with dry skin (so much so that it is believed that there may be a link between the two conditions) and, sometimes, atopic dermatitis, with which, however, there does not seem to be any particular connection.

Causes

The causes of nummular eczema are currently being studied, as it has not yet been clarified what exactly triggers skin inflammation.

THE MOST ACCREDITED THEORY

The most accredited hypothesis (but still to be demonstrated) concerns the association with dry skin; this condition, in fact, would make the skin less protected and would allow the penetration of some substances, such as soaps and detergents, with harmful, inflammatory and irritating effects.

OTHER HYPOTHESIS

The hypothesis that sees dry skin at the origin of discoid eczema is not the only one.

According to some studies, in fact, it would seem that nummular dermatitis was caused by the bite or sting of an insect .

According to others, however, it appears to be triggered by taking certain medicines, such as interferon and ribavirin for the treatment of hepatitis C or TNF-alpha blockers ( anti TNF-alpha ) for the treatment of arthritis .

Symptoms and Complications

The nummular eczema causes the appearance of skin patches with very variable characteristics. In fact, these spots can be:

• Oval or circular
• Large a few millimeters or a few centimeters
• Pink or brownish-red in color
• Dry, scaly and chapped, or moist, swollen and vesicose (ie, covered with blisters).
• Site of itching, irritation, burning and pain

The areas involved can be more than one: there are, in fact, patients with only one affected area and patients with more regions involved. In this second case, the skin between the various affected regions is not normal, but tends to be very dry.

WHERE ARE THE KEYS FORMED?

Patches can appear anywhere in the body. However, it is very rare that they arise on the face or scalp, while it is very common for them to form in the lower parts of the legs, in the forearms, in the trunk (understood as the chest, belly and back), in the hands and feet .

SPONTANEOUS RESOLUTION

Even if not treated with appropriate treatments, nummular eczema can heal itself; however, the spontaneous healing process could take several weeks, if not several months.

INFLUENCE OF THE CLIMATE

Nummular eczema symptoms tend to worsen in the presence of dry and / or very cold weather conditions; vice versa, they tend to improve in the presence of a sunny and humid climate.

IS IT CONTAGIOUS?

While not knowing the precise triggering causes, nummular eczema is certainly not caused by a contagious infectious agent; therefore, it is impossible that it can spread with the simple physical contact between people.

COMPLICATIONS

At certain times of the day (for example at night), the itching becomes very intense, so much so that the patient is led to rub his skin to feel relief. However, rubbing involves injury to the skin, especially if the affected area is covered with some bladder. A cutaneous infection can follow a bacterial infection, which determines the onset of further disorders such as high fever, appearance of pus and acute pain.

Diagnosis

The discoid eczema manifests itself with evident signs, which, however, can be confused due to their similarity to the signs of other dermatological diseases, sustained for example by fungi ( ringworm or fungal mycosis ) or by other substances present in the environment.

Therefore, in order to correctly diagnose a nummular eczema, not only a careful physical examination is needed, but also different culture tests and several allergy tests .

• Physical examination . In addition to carefully observing the suspected area, the dermatologist asks the patient certain questions regarding his medical history . This, in fact, may contain fundamental information regarding the causes and how dermatitis appeared. For example, knowing that patches have appeared after contact with certain substances could rule out nummular eczema and suggest contact dermatitis. It is good, however, that any hypothesis made is then confirmed by more specific laboratory analyzes, such as culture tests and allergy tests.
• Laboratory culture tests . Culture tests are performed on a sample of scales and on a skin pad ( skin swab ), both taken from the suspect area. From the analysis of the scales it is clear whether the spots are due to a fungal infection (ringworm) or not. The absence of fungi could mean that nummular eczema is actually in progress.

  With the skin swab, however, it is clear if there has been bacterial contamination. If the outcome of this second test is positive (ie the bacteria are present in skin wounds or blisters), antibiotic drugs must be given to the patient.

• Allergic tests . They serve to exclude the possibility that it may be contact dermatitis. On the skin of the patient under observation, in fact, different substances are applied which could trigger an allergic reaction; if there is no abnormal response to simple contact, the diagnosis favors nummular eczema.

Treatment

There are several therapeutic treatments for the treatment of nummular eczema; however, finding the right therapy and recovering from this skin inflammation is not always so simple, as each patient is a case in itself. Some individuals, in fact, respond very well to a certain remedy which, on the other hand, is ineffective and sometimes even counterproductive for other subjects (for example an allergic reaction may take place).

Here are all the possible treatments:

• Emollients
• Topical corticosteroids
• Oral corticosteroids
• Antibiotics
• Antihistamines

EMOLLIENT

What are emollients? All preparations capable of softening, moistening and making the surface layers of the skin more elastic are considered emollients. In general, they are based on oily substances.

Their application stops the irritation and allows the skin to restore its normal appearance.

Types of emollients . On the market, different types of emollients are available; in fact, there are creams, lotions and ointments, which have different amounts of oily substances. Generally, the higher the content of oily substances, the more effective the emollient is; however, the choice of the most suitable product also depends on the area affected by the spots and the type of skin.

How are emollients applied? They must be applied several times during the day and in good quantities. It is advisable not to rub them, but to spread them gently and always in the same direction as the hairs on the skin. In case of very dry skin, the application should be done every 3-4 hours.

Immediately after a shower, it is very important to spread the used preparation, because bathroom cleaners tend to dry out the skin.

Side effects . Emollients represent one of the most used products in the case of nummular eczema and dry skin, because they rarely cause side effects. The only contraindications could be allergic reactions to one of the substances contained in the emollient preparation. Therefore, at each first application, it is recommended to apply small amounts of product to see how the skin reacts.

CORTICOSTEROIDS FOR TOPICAL OR LOCAL USE

What are corticosteroids? Corticosteroids are powerful anti-inflammatory drugs belonging to the steroid family. Steroids are also hormones naturally present in the human body. For topical or local use means that the preparation is applied directly to the affected area.

Types of topical corticosteroids . There are more or less powerful corticosteroids. You can apply them in the form of creams or ointments, depending on the area affected and the severity of the dermatitis. For example, ointments are particularly suitable in the case of very severe nummular eczemas; creams, on the other hand, are very good for moderate nummular eczemas.

How are corticosteroids applied? Before using any corticosteroid drug, you should contact your doctor to be informed about how to administer it.

In general, these medicines should not be applied more than twice a day and for more than 3-4 weeks. Before applying to the affected area, it is advisable to soften the skin with an emollient, so as to favor the pharmacological effects of the corticosteroid in use.

Side effects . At the first administration, the patient may experience a slight discomfort, to which, however, he gets used in a short time. Possible side effects are: acne, increased hair growth, telangiectasia and thinning of the skin. Their appearance is usually due to prolonged use of the corticosteroid.

ORAL CORTICOSTEROIDS

Oral corticosteroids differ from topical corticosteroids only by the route of administration, which is by mouth, and by the type of side effects.

Main side effects of oral corticosteroids:

• Hypertension
• Weight gain
• Osteoporosis

ANTIBIOTICS

Antibiotics, available in both topical (or local) and oral (to be taken by mouth), are administered only if the area affected by nummular eczema has developed a bacterial infection.

Before using them, it is recommended to consult your doctor.

ANTIHISTAMINES

Antihistamines are medicines that block the release of histamine, a compound produced by some cells of the body and released in the event of inflammation.

They are prescribed if the patient with nummular eczema complains of severe itching and intense irritation, especially during the night.

Before using them, it is recommended to consult your doctor.

OTHER USEFUL TIPS

In addition to the above remedies, patients with nummular eczema are advised to:

• Avoid excessive use of the most common soaps and bath detergents, which tend to dry out and irritate the skin.
• Get the most suitable detergents for dry skin from your doctor and a pharmacist.
• Cut the nails and keep them very short, so as not to scratch the skin when, at the onset of itching and irritation, you scratch yourself. In fact, scratches could start a bacterial infection.
• Continue to apply the emollients even after healing has taken place.

Prognosis

If no complications arise (for example a bacterial infection) and the most appropriate treatment is identified (the type of emollient, the kind of corticosteroids, etc.), nummular eczema can be cured in a few weeks.