From the Guidelines
Discoid eczema should be managed with topical corticosteroids, moisturizers, and avoidance of triggers to reduce morbidity and improve quality of life. The condition is characterized by coin-shaped patches that are intensely itchy, red, and often develop crusting or scaling. Treatment typically involves topical corticosteroids such as betamethasone valerate 0.1% or mometasone furoate 0.1% applied once or twice daily to affected areas for 1-2 weeks for acute flares 1. For maintenance, less potent steroids like hydrocortisone 1% may be used. Moisturizers should be applied liberally at least twice daily, with emollients like petroleum jelly or ceramide-containing creams being particularly effective.
Key Considerations
- Antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg at bedtime can help control itching
- For infected lesions, topical antibiotics like fusidic acid or oral antibiotics such as flucloxacillin 500mg four times daily for 7 days may be necessary
- Avoiding triggers is essential - these commonly include harsh soaps, hot water, wool clothing, stress, and allergens
- Bathing should be limited to 5-10 minutes using lukewarm water and gentle cleansers
Discoid eczema occurs due to skin barrier dysfunction and immune dysregulation, causing inflammation and moisture loss, as noted in the guidelines for atopic dermatitis management 1. Without proper treatment, the condition can become chronic with repeated flares, so consistent moisturizing and prompt treatment of flares are crucial for management. The most recent guidelines for the management of atopic dermatitis in adults with topical therapies support this approach 1.
From the Research
Discoid Eczema Treatment
- Discoid eczema, also known as nummular eczema, is a type of eczema that presents as coin-shaped patches on the skin 2, 3.
- Treatment for discoid eczema typically involves the use of topical corticosteroids, which are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions 2.
- Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 2.
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 2.
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 2.
Additional Treatment Options
- In addition to topical corticosteroids, other treatment options for eczema include skin moisturization, calcineurin inhibitors, and proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas 3.
- Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation 3.
- Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection, and use of systemic antibiotics in infected lesions is warranted 3.
Unrelated Studies
- There is one study that is not relevant to the treatment of discoid eczema, which discusses the mechanism by which energy is released at the level of the flavoenzyme molecule during the transfer of two electrons 4.