From the FDA Drug Label
Apply triamcinolone acetonide cream USP, 0. 1% as appropriate, to the affected area two to three times daily. Rub in gently. The treatment for nummular eczema on the back may include applying triamcinolone acetonide cream USP, 0.1% to the affected area two to three times daily and rubbing it in gently 1.
- Key points:
- Apply a small amount of cream to the lesion
- Rub in gently
- Reapply as needed
- Consider using an occlusive dressing for management of recalcitrant conditions, but discontinue use if an infection develops.
From the Research
Treatment for nummular eczema on the back should start with a medium to high-potency topical corticosteroid, such as triamcinolone 0.1% or fluocinonide 0.05% cream, applied thinly to affected areas twice daily for 1-2 weeks, then taper to once daily for another week, as supported by the most recent and highest quality study 2.
Key Considerations
- The goal of treatment is to reduce inflammation, restore the skin barrier, and prevent the itch-scratch cycle that worsens nummular eczema.
- Daily moisturizing is essential, using a thick, fragrance-free moisturizer like CeraVe, Vanicream, or Eucerin, applied at least twice daily, especially after bathing while skin is still damp.
- Lifestyle modifications, such as taking short, lukewarm showers, avoiding scratching, wearing loose cotton clothing, and using fragrance-free laundry detergent, are also crucial.
- If the condition is severe or infected, oral antibiotics like cephalexin or doxycycline may be prescribed, and in resistant cases, oral immunosuppressants or phototherapy might be considered.
Treatment Options
- Topical corticosteroids: medium to high-potency options like triamcinolone 0.1% or fluocinonide 0.05% cream, applied thinly to affected areas twice daily for 1-2 weeks, then taper to once daily for another week.
- Non-steroidal options: tacrolimus 0.1% ointment or pimecrolimus 1% cream, for maintenance therapy.
- Moisturizers: thick, fragrance-free options like CeraVe, Vanicream, or Eucerin, applied at least twice daily.
- Oral antibiotics: cephalexin or doxycycline, for severe or infected cases.
- Oral immunosuppressants or phototherapy: for resistant cases.
Supporting Evidence
- A 2023 study published in The Journal of allergy and clinical immunology found that nummular eczema is a variant of atopic dermatitis with a codominant TH2/TH17 immune response, supporting the use of topical corticosteroids and other treatments that target these pathways 3.
- A 2020 review published in Recent patents on inflammation & allergy drug discovery discussed the evaluation, diagnosis, and treatment of nummular eczema, highlighting the importance of topical corticosteroids and lifestyle modifications 4.
- A 2022 study published in The Cochrane database of systematic reviews found that potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids for treating eczema, and that once daily application is probably as effective as twice daily application 2.