From the FDA Drug Label
DOSAGE AND ADMINISTRATION: Apply a thin layer of clobetasol propionate gel, cream or ointment to the affected skin areas twice daily and rub in gently and completely. Clobetasol propionate gel, cream and ointment are super-high potency topical corticosteroids; therefore, treatment should be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used. The treatment for nummular eczema (nummular dermatitis) is applying a topical corticosteroid, such as clobetasol propionate gel, cream, or ointment, to the affected skin areas twice daily for a limited duration of 2 consecutive weeks.
- Key considerations:
- Apply a thin layer and rub in gently and completely
- Do not use occlusive dressings
- Limit treatment to 2 consecutive weeks and do not exceed 50 g per week 1
From the Research
Nummular eczema treatment should start with high-potency topical corticosteroids, such as very potent or potent topical corticosteroids, as they are probably more effective than mild topical corticosteroids in reducing inflammation and itching, as shown in a network meta-analysis of 291 studies involving 45,846 participants 2.
Treatment Approach
For mild cases, regular application of moisturizers like petroleum jelly or ceramide-containing creams immediately after bathing can help lock in moisture.
- Topical corticosteroids such as triamcinolone 0.1% or betamethasone valerate 0.1% cream applied twice daily for 1-2 weeks can reduce inflammation and itching.
- For moderate to severe cases, stronger prescription corticosteroids may be needed, along with antihistamines like cetirizine 10mg daily to control itching.
- If infection is present, topical antibiotics such as mupirocin or oral antibiotics like cephalexin 500mg four times daily for 7-10 days may be prescribed.
Lifestyle Modifications
To prevent recurrence, it is essential to:
- Avoid hot water
- Use gentle fragrance-free soaps
- Pat skin dry instead of rubbing
- Wear loose cotton clothing
- Maintain humidity in your home
- Identify and avoid triggers
Additional Therapies
Wet wrap therapy can help severe flares by applying medication, covering with wet bandages, then dry bandages for several hours. In some cases, dupilumab, a monoclonal antibody against the receptor for interleukin(IL)-4 and IL-13, may be effective in treating nummular eczema, as shown in a study of 30 adult patients 3. Methotrexate may also be an effective treatment for children with moderate to severe nummular eczema that has failed to respond to conventional topical therapy, as shown in a retrospective study of 28 patients 4.