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Nummular Eczema

Nummular eczema, also known as discoid eczema, orbicular eczema, nummular dermatitis or discoid dermatitis, is a skin condition causing oval or coin-shaped patches. The spots may be itchy, dry, crusted and ooze clear fluid. While often chronic, the condition is entirely treatable.

Last Modified: September 21, 2022
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Nummular Eczema Symptoms

Nummular eczema symptoms often appear after a skin injury, such as a chemical burn, abrasion or insect bite, but there are other causes.

The symptoms of nummular eczema are:

  • Coin-shaped lesions
  • Itching
  • Burning
  • Blistering
  • Dry, scaly skin surrounding lesions
  • Red, pinkish or brown skin discoloration
  • New, raised flare-ups on top of old lesions

The condition may start as tiny bumps or blisters and result in one or multiple patches of small coin-shaped lesions, which can last for up to several months.

There are different types of eczema with similar symptoms, such as dyshidrotic eczema, which appears primarily on the appendages. Nummular eczema also typically develops on the legs, hands, arms and torso. It appears less frequently on the face.

The first signs of nummular eczema are tiny blister-like sores. The coin-shaped spots that follow may vary with your skin tone. If you have a light skin tone, they will be red or pink. On darker skin tones, they will appear browner in color. The spots will be raised and often scaly.

If you have the following symptoms, you may have developed an infection:

  • Excessive oozing
  • A yellow crust
  • Skin that feels hot and tender
  • Swelling
  • Fever
  • General malaise or feeling of being unwell

If you are experiencing any of these symptoms and are concerned you may have developed an infection, such as Staphylococcus aureus (staph), you should consult your doctor. Your doctor can offer treatment to resolve the eczema and infection.

What Causes Nummular Eczema?

Researchers have not identified a precise cause of nummular eczema. However, people with nummular eczema often have a family history of dermatitis and allergies, such as hay fever or asthma.

Specific triggers can lead to or make the condition worse. In addition to injury to the skin, they include the presence of dry or sensitive skin. Other triggers may include exposure to metals such as nickel, cobalt and chromate or the triggers of different eczema types, such as the poor lower-body blood flow linked to stasis dermatitis and varicose veins.

Certain medications, allergens and skin care products may also lead to flare-ups of nummular eczema.

Who’s at Risk for Nummular Eczema?

Studies vary, but most indicate nummular eczema to be most common in men 50 years and older and women under 30. It is rare in children, unless they have severe atopic dermatitis.

Other types of environmental triggers include:

  • Allergies: People with allergies or hypersensitivity to metals such as nickel, chromate or cobalt may develop nummular eczema. The mercury in older fillings can also trigger the immune system to develop eczema.
  • Stress: A significant contributor because of its impact on immune response. The anxiety and stress associated with nummular eczema can also compound this.
  • Alcohol consumption: Though studies vary, some people report that alcohol worsens their eczema symptoms.
  • Medications: Certain medications, including diuretics, interferon, ribavirin, monoclonal antibodies, antivirals, statins, isotretinoin and retinoids, cause dry skin, leading to a higher risk of nummular eczema.
  • Environmental Irritants: Harsh household cleaners, chemicals and soaps may trigger symptoms.
  • Temperature Changes: Reduced humidity in winter and increased heat in summer may worsen nummular eczema.
  • Injuries: Frequent cuts and abrasions to the skin, whether a bug bite or a contact injury, are likely to cause eczema flare-ups.
  • Skin sensitivities: People sensitive to heavily fragranced skin care products, rough wool or tight nonbreathable fabric may risk a flare-up if they come in contact with them.

For these reasons, it’s essential to protect your skin, monitor the moisture in the air, avoid harsh chemicals, use stress release techniques, drink in moderation and have a skin care regime that involves regular moisturizer and avoid hot water. Good self-care can help clear your skin and prevent more nummular eczema flare-ups.

Diagnosing Nummular Eczema

Your doctor or dermatologist can provide an accurate diagnosis of the type of eczema you may have. A dermatologist can also refer you to an allergist to diagnose or confirm any suspected triggers.

Nummular eczema can resemble several other conditions, including other eczemas such as dermatitis or fungal infections. The dermatologist may also perform a skin biopsy or scraping, which involves taking a small piece of the affected skin to test for a condition.

Ringworm vs. Nummular Eczema

Ringworm is a contagious skin infection that can resemble nummular eczema. Your doctor or dermatologist can tell the difference between them.

While both conditions may be itchy and bumpy, ringworm typically only appears as one or two lesions. Ringworm often has a red dot, with an area of clearer skin around it, surrounded by another ring of red, whereas nummular eczema is a solid color.

Treating Nummular Eczema

Chronic nummular eczema seldom improves without relatively aggressive treatment, including antibiotics, in the event of infection. Your doctor’s goal will be to ease discomfort and clear your skin. To that end, they will develop a personalized treatment plan.

Topical treatments frequently include corticosteroid ointments, which are applied as an ointment to damp skin several times a day. Once lesions have improved, they may switch to nonsteroidal moisturizing lotions or creams. Tar cream and calcineurin inhibitors are frequently used treatments.

Wet wrapping is a complementary treatment used to calm and hydrate the skin. It involves moistening the affected area with a moist dressing, usually after moisturizing and covering it with a dry one.

Some eczema specialists use UV light therapy to reduce itch and inflammation when a topical eczema treatment isn’t working.

Nummular Eczema Diet

Patients sometimes report that certain foods seem to cause their eczema to flare up. Your doctor may recommend that you track what you eat and your symptoms as well as test an elimination diet, avoiding any foods that are suspected as triggers.

The link between food allergies, food sensitivities and eczema has not been conclusively established. Some studies indicate that food-triggered symptoms may be more common in children.

When to See a Doctor

If you have tried over-the-counter oral allergy or topical anti-itch treatments, such as non-prescription hydrocortisone cream, calamine lotion or colloidal oatmeal moisturizers, and your nummular eczema is not clearing, see your dermatologist.

Nummular eczema may have several causes, but allergies are often the reason nummular eczema fails to go away. If your dermatologist suspects you have an undiagnosed allergy, they can refer you to an allergy specialist who may conduct patch testing to discover the cause.

With proper treatment and good self-care, your nummular eczema may be completely cleared.

Please seek the advice of a medical professional before making health care decisions.
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