Nummular eczema is characterized by circular or oval "coinlike" lesions. Initially, this eruption consists of small edematous papules that become crusted and scaly. The most common locations are on the trunk or the extensor surfaces of the extremities, particularly on the pretibial areas or dorsum of the hands.
Synonym: Discoid eczema
Nummular eczema occurs more frequently in men and is most commonly seen in middle age.
The etiology of nummular eczema is unknown. These are not definitely established: psychogenic stresses, focal sepsis, food allergies, alcohol, debility and drugs are usually held responsible. A dry skin and cold weather may be associated with it. Whether nummular eczema represents a variant of atopic eczema is controversial.
Nummular eczema sholud be distinguished from circular patches of infective eczema and tinea circinata. Both of these are asymmetrical, acute and non-recurring conditions. Focal sepsis may produce bilaterally symmetrical patches of infective eczematoid dermatitis resembling discoid dermatitis; these do well with administration of appropiate antibiotics, with the surgical removal of the septic focus and the local use of mild antiseptics.
Dermatitis papulosa alba and miliarial dermatitis are seen in the hot summer, on forearms; sweat retention may be the exciting cause. Sometimes, discoid dermatitis may be associated with dyshidrosis of plams and soles, and discoid patches of keratoderma.
The treatment of nummular eczema is similar to that for other forms of dermatitis. Therapy of Nummular eczema is directed toward avoidance of irritants, identification of possible contact allergens, treatment of coexistent infection, and application of topical glucocorticoids. Whenever possible, the hands should be protected by gloves, preferably vinyl.
Most patients can be treated with cool moist compresses (dressings) to dry and debride acute inflammatory lesions and to decrease swelling, followed by application of a mid- to high-potency topical glucocorticoid in a cream or ointment base. As with atopic dermatitis, treatment of secondary infection by staphylococci or streptococci is essential for good control. Additionally, patients with hand dermatitis should be examined for dermatophyte infection by KOH preparation and culture.
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