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Coin-like eczema
Last reviewed: 23.04.2024
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Coin-like (numular) eczema is a form of eczema, characterized by the presence of often generalized, highly itchy, rounded (coin-like) foci of eczematous inflammation. Adults get sick more often, men more often than women.
Symptoms of coin-like eczema
The onset is gradual, without obvious deterioration and without the presence of eczema in the anamnesis. Coin-like eczema often begins with several isolated foci on the legs; over time, there are multiple foci without any specific location. Foci are often resolved or improved after applying topical corticosteroids, but after the cessation of their use, they sometimes return to the same place.
Clearly bounded, flaky, round eczematous plaques appear on the trunk and extremities. Moisture of the foci and vesiculation are characteristic for outbreaks of the disease. Secondary infection can trigger an outbreak of disease. Crusts of honey-yellow color indicate secondary impetigination.
This is one of the most difficult forms of eczema for treatment. The course of the disease is changeable and unpredictable. This condition can be chronic and recurrent for several years. Having formed, the foci tend to maintain their size and recur on previously affected skin.
Diagnosis of coin-like eczema
A patch test gives a positive result in 1/3 of the cases. Sowing can reveal the presence of Staphylococcus aureus. Antibiotic treatment usually helps, but often does not lead to remission.
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Differential diagnosis
Psoriasis (often more symmetrical and "geographical" nature of lesions with silvery scales). Fungal infections (foci regress in the center and flake around the periphery, a study with KOH helps in making a differential diagnosis). Cutaneous T-cell-specific lymphoma on the lower limbs (it can be taken as a coin-like eczema, and biopsy will help to exclude the diagnosis).
Treatment of coin-like eczema
It is necessary to cancel all the optional external moisturizers, ingested medicines, dietary supplements and herbal preparations for a period of at least 3-4 months. A study should be conducted for the presence of mycosis of the feet; fungal infection, if any, are treated with antifungal drugs, since sometimes generalized coin-like eczema can be an "id-reaction to a fungal infection." It is necessary to aggressively apply a topical steroid medium strength and emollient emollients. Topical steroid is applied to the affected skin twice a day for 2-3 weeks. It is best to continue treatment for a week or a little longer than necessary to resolve foci. The effectiveness of a topical steroid is enhanced by occlusion under a polyethylene film or under a special suit for a sauna, as well as when taking a skin moisturizing bath before applying a topical steroid or using both of these methods.
Secondary infection is treated with systemic anti-staphylococcal antibiotics (eg cephalexin 250 mg four times a day). In case of itching, antihistamines are prescribed. For long-term treatment, systemic steroids are not used. Phototherapy can lead to the resolution of foci if external therapy is ineffective. Ultraviolet in the narrow and wide spectrum is best suited for phototherapy; psoralen plus ultraviolet A can be used if ultraviolet B was ineffective.