Nummular eczema

Nummular eczema is a noninfectious inflammatory dermatosis with multifactorial trigger etiology in combination with epidermal barrier dysregulation. It is characterized by severe pruritus and well-demarcated coin-shaped lesions and, in many cases, refractory course of disease. Elimination of trigger factors in combination with topical and systemic anti-inflammatory and antimicrobial therapy according to stage of disease is essential. Topical treatment of first choice during the acute stage (vesicles, erosion, exudation) is corticosteroids in combination with desiccating, antiseptic solutions and wet bandages. In subacute and chronic eczema, topical corticosteroids as pastes and calcineurin inhibitors are recommended. In disseminated or relapsing eczema, combination with phototherapy can be useful. Systemic antimicrobial and anti-inflammatory therapy (antibiotics, corticosteroids) is indicated in severe cases or recurrent refractory eczema. In single cases immunosuppressive therapy with other agents (ciclosporin, methotrexate) may be necessary to achieve remission.