From the Research
Treatment guidelines for nummular dermatitis should prioritize the use of high-potency topical corticosteroids and moisturizers as first-line therapy, with consideration of systemic treatments like dupilumab for severe cases, as evidenced by a recent study showing its effectiveness in adults with nummular eczema phenotype of atopic dermatitis 1.
Key Considerations
- Nummular dermatitis is characterized by sharply defined, oval or coin-shaped, erythematous, eczematous plaques, typically ranging from 1 to 10cm in diameter, and is often intensely pruritic 2.
- The diagnosis is mainly clinical, based on the characteristic round to oval erythematous plaques in a patient with diffusely dry skin, and may involve dermoscopy or patch testing to rule out other conditions or contact allergies 2.
- First-line treatment includes:
- Daily application of medium to high-potency topical corticosteroids (such as triamcinolone 0.1% or fluocinonide 0.05%) to affected areas twice daily for 2-3 weeks, followed by gradual tapering to prevent rebound.
- Liberal use of fragrance-free moisturizers like petroleum jelly or ceramide-containing creams, applied at least twice daily, especially after bathing while skin is still damp.
- Patients should take short, lukewarm showers using mild, fragrance-free cleansers and avoid known irritants such as harsh soaps, wool clothing, and environmental allergens.
- For severe itching, oral antihistamines like hydroxyzine (25mg three times daily) or cetirizine (10mg daily) can provide relief.
- In cases resistant to topical therapy, treatment may be escalated to include wet wrap therapy, phototherapy, or systemic immunosuppressants like cyclosporine or methotrexate for severe cases, with dupilumab being a promising option for adults with nummular eczema phenotype of atopic dermatitis 1.
- Addressing secondary bacterial infections with appropriate antibiotics is crucial, as Staphylococcus aureus colonization often exacerbates nummular dermatitis.
Additional Considerations
- The chronic, relapsing nature of nummular dermatitis requires patient education about long-term maintenance therapy with regular moisturizing and early intervention at signs of flare-up.
- Methotrexate has been shown to be effective and well-tolerated in children with moderate to severe nummular eczema that has failed to respond to conventional topical therapy 3.