Nummular eczema (also known as discoid eczema and nummular dermatitis) is a form of eczema that can occur at any age. It looks different than other types of eczema and can be difficult to treat because it seems to affect people differently.

The word “nummular” comes from the Latin word for “coin,” as the spots can look coin-shaped on the skin. The spots may be very itchy or not itchy at all. They can be very dry and scaly or can become wet and open.

The cause of nummular eczema (nummular dermatitis) is unknown, but it does not seem to run in families.

Known triggers for nummular eczema include:

• Damage to the skin such as through an insect bite, scrapes and scratches, chemical “burns”
• A reaction to inflammation (as with atopic dermatitis and/or statis dermatitis) elsewhere on the body
• Dry skin especially in the winter
• Metals like nickel
• Poor blood flow or swelling in the lower legs
• Medications like topical antibiotic creams, isotretinoin and interferon

Because nummular eczema (nummular dermatitis) can look like ringworm, it is important to make sure that it is not a fungal infection, especially if it is not responding to treatment. This can usually be done by your health care provider with a skin scraping or a fungal culture.

Like atopic dermatitis, nummular eczema (nummular dermatitis) can get infected by bacteria — usually staph. Make an appointment with your doctor if you think you have an infection on your skin where the nummular eczema appears.

Nummular eczema appears more frequently in men, usually between the ages of 55-65. Women usually get their first flare of nummular eczema between the ages of 13-25. It can also affect children.What does nummular eczema – nummular dermatitis look like?

Symptoms of nummular eczema (nummular dermatitis) include:

• Coin-shaped lesions on arms, legs, torso and/or hands
• Itching and burning
• Lesions that are oozing liquid or have crusted over
• Red, pinkish or brown, scaly and inflamed skin around the lesions

Nummular dermatitis treatment

Like atopic dermatitis, nummular eczema (nummular dermatitis) benefits from moisturizers to calm and protect the damaged skin barrier.

In many cases, you may receive a prescription for a steroid medication to calm the inflammation as well. For some reason, the milder and moderate-potency steroid creams may not be of much help with nummular eczema (nummular dermatitis). More powerful steroid creams are frequently required. Fortunately, nummular eczema (nummular dermatitis) tends to disappear completely after the right treatment.

In cases where steroids are not appropriate, or when you have used them for a long time, your doctor may prescribe phototherapy, coal-tar creams, or a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel). These medications are called topical calcineurin inhibitors (TCIs) are approved for use by adults and children two years of age or older.

Topical or oral antibiotics may be used when there is a bacterial infection on the skin. In very severe cases, systemic steroids (taken by mouth or given by injection) may be used for a short time to calm symptoms, though they are not recommended.

Atopic dermatitis may look like nummular eczema, especially on people of African-American or Asian descent.

Will nummular eczema ever go away?

Many people, even those who have a severe nummular eczema, seem to clear up completely and do not appear to have the long-term issues like other forms of eczema.

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This common form of eczema causes small, intensely itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. It is is twice as common in women as it is in men.

Because of the association with seasonal allergies, these eczema blisters are known to erupt more frequently during the spring allergy season. The blisters may last up to three weeks before they begin to dry and can sometimes be large and painful. As the blisters dry, they may turn into skin cracks or cause the skin to feel thick and spongy, especially if you’ve been scratching the area.

Deep blisters on the sides of the feet are typical of this type of eczema

Doctors also may refer to dyshidrotic eczema as:

• Cheiropompholyx
• Dyshidrosis
• Foot-and-hand eczema
• Pompholyx
• Vesicular eczema
• Palmoplantar eczema

There is no cure for this type of eczema, but the good news is, in many cases it’s manageable. And like all types of the condition, it isn’t contagious. You cannot “catch” this condition from another person, or give it to someone else.

What does dyshidrotic eczema look like?

All types of eczema cause itching and redness. But some, like dyshidrotic eczema, look and act slightly different than others. It is possible to have dyshidrotic eczema and another form of eczema such as contact dermatitis, at the same time.

Symptoms of dyshidrotic eczema include:

• Deep-set blisters on the edges of the fingers, toes, palms and soles of the feet
• Itching
• Redness
• Flaking
• Scaly, cracked skin
• Pain

Dyshidrotic eczema blisters can be hard to see on the palms and fingers because the skin is thicker here

It’s important to understand which type of eczema you may have and also your symptoms and triggers, so that you can better treat and manage it. The only way to be sure that you have dyshidrotic eczema, is to make an appointment with your doctor.

What causes dyshidrotic eczema?

Dyshidrotic eczema usually appears in adults ages 20 through 40 but it can also affect children. People with contact dermatitis, atopic dermatitis or hay fever, are at higher risk of developing dyshidrotic eczema. Dyshidrotic eczema seems to run in families, so if you have a close relative with this form of eczema, your chance of also developing it is increased.

There are some common triggers for dyshidrotic eczema:

• Stress
• Pollen
• Moist hands and feet from excessive sweating or prolonged contact with water
• Nickel in everyday objects such as jewelry, keys, cell phones, eyeglass frames, stainless steel items, and metal buttons, snaps and zippers
• Nickel in foods such as cocoa, chocolate, soy beans, oatmeal, nuts, almonds, fresh and dried legumes, and canned foods
• Cobalt in everyday objects such as cobalt-blue colored dishware, paints and varnishes; certain medical equipment; jewelry; and in metal snaps, buttons and zippers
• Cobalt in foods such as clams, fish, leafy green vegetables, liver, milk, nuts, oysters, and red meat
• Chromium salts used in the manufacturing of cement, mortar, leather, paints and anticorrosives

Treatment for dyshidrotic eczema

At-home treatment for dyshidrotic eczema includes soaking hands and feet in cool water or applying compresses for 15 minutes to the affected area two to four times a day followed by a rich moisturizer or a skin barrier repair cream.

For more severe cases of dyshidrotic eczema, a provider may prescribe topical steroids, TCIs or phototherapy. Additionally, the provider may drain the blisters in-office, and/or give a dose of Botox in the hands and feet to reduce sweating and wetness, which are known triggers for this form of eczema.

Dyshidrotic eczema has the tendency to get infected, which can delay clearing of symptoms. If you suspect you have an infection in the area where the eczema appears, make an appointment with your provider.

Atopic dermatitis and contact dermatitis may look like dyshidrotic eczema.

Tips for managing dyshidrotic eczema

There is no surefire way to prevent dyshidrotic eczema. However, good skin care and moisturizing can help strengthen your skin against irritation, so that it doesn’t flare up, or get worse. The most important thing to remember is to be consistent.

Some basic things you can do to help control your dyshidrotic eczema:

• Wash the affected skin with a mild cleanser and pat gently dry
• Remove rings and other jewelry when you wash your hands so water doesn’t linger on you skin
• Moisturize after washing hands/feet or immersing them in water
• Moisturize frequently during the day when your skin starts to feel dry
• Wash your hands or feet immediately after coming into contact with a potential trigger
• Learn to manage stress as it is a common trigger of dyshidrotic eczema
• When possible, avoid rapid changes of temperature and activities that make you sweat
• Keep your fingernails short to help prevent scratching from breaking the skin

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Considered a chronic form of eczema, seborrheic dermatitis appears on the body where there are a lot of oil-producing (sebaceous) glands like the upper back, nose and scalp. The exact cause of seborrheic dermatitis is unknown, although genes and hormones play a role. Microorganisms that live on the skin naturally can also contribute to seborrheic dermatitis.

People of any age can develop seborrheic dermatitis including infants (known as “cradle cap”). However, it most commonly affects adults between the ages of 30-60 and infants under 3 months.

Seborrheic dermatitis on the chest that shows round, red areas and slight scaling

Common triggers for seborrheic dermatitis include:

• Stress
• Hormonal changes or illness
• Harsh detergents, solvents, chemicals and soaps
• Cold, dry weather
• Medications such as psoralen, interferon and lithium

In general, seborrheic dermatitis is slightly more common in men than in women. Patients with certain diseases that affect the immune system (such as HIV/AIDS and psoriasis) and the nervous system, such as Parkinson’s disease, are also at increased risk of developing seborrheic dermatitis. It can also affect people who have epilepsy, alcoholism, acne, rosacea and mental health issues such as depression and eating disorders.

Seborrheic dermatitis is not contagious.

What does seborrheic dermatitis look like?

Seborrheic dermatitis often appears on the scalp, where symptoms may range from dry flakes (dandruff) to yellow, greasy scales with reddened skin. Patients can also develop seborrheic dermatitis on other oily areas of their body, such as the face, upper chest and back.

Seborrheic dermatitis appears in oily skin areas like the side of the nose and causes redness and yellow scale

Common symptoms of seborrheic dermatitis include:

• Redness
• Greasy, swollen skin
• White or yellowish crusty flakes
• Itch and burning
• Pink-colored patches, most prominent in people with dark skin

What causes seborrheic dermatitis?

The exact cause of seborrheic dermatitis is unknown, although genes and hormones play a role. Microorganisms such as yeast, that live on the skin naturally can also contribute to seborrheic dermatitis. Unlike many other forms of eczema, seborrheic dermatitis is not the result of an allergy.

People of any age can develop seborrheic dermatitis including infants (known as “cradle cap”). It is slightly more common in men than women.

People with certain diseases that affect the immune system, such as HIV or AIDS, and the nervous system, such as Parkinson’s disease, are believed to be at an increased risk of developing seborrheic dermatitis.

How is seborrheic dermatitis diagnosed?

Seborrheic dermatitis can often look like – or even appear with – other skin conditions such as atopic dermatitis and psoriasis.

There is no test for diagnosing seborrheic dermatitis. Your doctor will ask about your medical history and also perform a physical examination of your skin. Sometimes, the doctor with scrape a bit of skin, mix it with a chemical and look at it under a microscope to determine if there is a fungal infection. Similarly, a skin biopsy (a procedure in which a small sample of skin is taken) may be required to rule out the other conditions that look like seborrheic dermatitis.

If you are experiencing symptoms, make an appointment with your doctor to get the correct diagnosis and treatment.

Seborrheic dermatitis treatment

Treatment for seborrheic dermatitis focuses on loosening scale, reducing inflammation and swelling, and curbing itch.

In mild cases, a topical antifungal cream or medicated shampoo (such as ketoconazole, selenium sulfide, coal tar, and zinc pyrithione) may be enough to control symptoms.

Guidelines for treating seborrheic dermatitis include:

• For the scalp: Alternate between using your regular shampoo and a medicated dandruff shampoo. If you are African American, wash with the medicated shampoo once weekly. Taper off as your symptoms improve.
• For the body:  Wash daily with a gently cleanser that has 2% zinc pyrithione, followed by a moisturizer. To further soften scale, use a cream containing salicylic acid and sulfur or coal tar.

In more severe cases, you may receive a prescription for a mild corticosteroid medication to calm the inflammation as well. Use topical corticosteroids only as directed—that is, when the seborrheic dermatitis is actively flaring.

In cases where corticosteroids are not appropriate, or when they have been used for a prolonged period, a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed. These medications are called topical calcineurin inhibitors (TCIs) and are approved for use by adults and children two years of age or older. Oral antifungal agents may be used in very severe cases.

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When your skin comes into contact with a substance in the environment that you are allergic to, it may react by causing your skin to itch and become red. This is called contact dermatitis.

Types of Contact Dermatitis

There are many types of contact dermatitis. The three most common types are irritant, allergic and contact urticaria (hives).

Irritant Contact Dermatitis

Irritant contact dermatitis is the most common type of contact dermatitis. It can develop quickly when the skin touches an irritating chemical, is rubbed too hard, or comes in contact with heat. These substances break through the skin barrier and can cause inflammation.

If the skin is already open with a wound, or if you have active atopic dermatitis, it is much easier for these irritants to enter and cause irritant contact dermatitis.

Allergic Contact Dermatitis

Allergic contact dermatitis is the second most common contact dermatitis type. Unlike, irritant contact dermatitis, the skin can take 48 to 96 hours to develop a reaction.

The first time the skin comes in contact with a new allergen, it sends a piece of the allergen off to the immune system for analysis and storage in the immune system’s memory bank, but does not cause a reaction. This process is called sensitization.

When the skin comes into contact with the substance over and over, the immune system “remembers it” and develops an itchy skin response. Because it can take a few days for the immune system to recognize the chemical, the skin symptoms may be appear several days after actual exposure.

Contact Urticaria

Contact urticaria, also known as hives, is a less common form of contact dermatitis. With contact urticaria, swelling and redness usually happen right away after the skin comes in contact with an irritating substance. It is usually not long-lasting.

There is rare but serious risk of an anaphylactic reaction (a severe allergic reaction that causes the throat to swell, chest tightness, and other symptoms) that can coincide with contact urticaria. If you think you are having an anaphylactic reaction, contact your doctor immediately.

What are the symptoms of contact dermatitis?

Irritant contact dermatitis usually stays on the skin where the exposure to the allergen occurred. If the exposure is to a strong irritant, an immediate reaction including pain, swelling and sometimes blistering can be present. If there is ongoing exposure to a mild irritant such as water or soap, the reaction can occur over a period of weeks to months and involve dryness, itching and cracking.

Allergic contact dermatitis may also be limited to the site of original contact, but more often spreads. The skin becomes red, hot, itchy and may “weep.” Contact dermatitis can sometimes be very difficult to distinguish from atopic dermatitis, another form of eczema. Your doctor can help you with a correct diagnosis.

The skin signs and symptoms of contact dermatitis may appear similar to those of atopic dermatitis.

What causes contact dermatitis?

There are many different causes or triggers for contact dermatitis.

Irritant contact dermatitis may develop from everyday substances such as water, too much pressure or friction on the skin and weather changes such as extreme temperature and humidity.

There are a large number of potential allergy-producing chemicals. Here are some common ones:

Metals

Nickel allergy is extremely common among adults and children. Nickel is found in a range of metallic items, such as jewelry, zippers, buttons, belt buckles and coins. It is also found in some less obvious places like, cell phones, white gold, some orthopedic joint replacements and certain foods.

Cobalt is found in metals, including nickel, and people allergic to nickel are often allergic to cobalt because of its widespread use. Cobalt is also used in personal products such as hair dyes and antiperspirants.

Chromium salts, often found in paints, cement, and leather products may cause allergic contact dermatitis and sometimes irritant contact dermatitis symptoms.

Fragrances

Fragrances are common triggers of ACD especially in people with damaged skin barriers, such as with atopic dermatitis. These substances can be found in various cosmetics, perfumes, food flavorings and toothpastes.

Anitibacterial Ointments

Antibacterial ointments such as neomycin and bacitracin are often used to treat everyday scratches and wounds, but some people develop allergic reactions.

Formaldehyde

Formaldehyde is a preservative. It is also a top adult and child allergen. Formaldehyde is in many places including household disinfectants, vaccines, glues and adhesives, cigarette smoke and embalming fluid.

Formaldehyde-releasing preservatives are in personal care products such as cosmetics and may trigger some individuals who are allergic to formaldehyde. Hidden sources of formaldehyde include “permanent press” and “wrinkle- resistant” clothing and the artificial sweetener, aspartame.

Isothiazolinones

Isothiazolinones, including methylchloroisothiazolinone and methylisothiazolinone (MCI/MI) are used in many personal care products to prevent bacteria from growing and protect the product from oxygen and light damage. They are often found in many “wash-off” items such as shampoos, body washes and cosmetics. As well, they are found in some wet wipes, baby wipes and moistened toilet tissues.

Cocamidopropyl betaine

Cocamidopropyl betaine (CAPB) is used mainly as a surfactant in cosmetic and personal care products. Surfactants clean skin and hair by helping water mix with oil and dirt so that they can be rinsed away. It may also be found in household cleaning products, including laundry detergents, hand dishwashing liquids and hard surface cleaners. CAPB can be safe in wash-off products at low concentration levels but should be avoided in leave-on products.

Paraphenylene-diamine

Paraphenylene-diamine (PPD) is a strong chemical used in hair-dye. It is not allowed in products that are meant to touch the skin due to the allergy potential.

Nevertheless, PPD continues to be used in various unregulated products for the skin such as temporary tattoos. PPD is often used to dye shoes black, and can cross-react with dyes used in clothing and some medications, such as antihistamines.

What is patch testing?

A patch test can help identify allergies

Patch testing is an important tool to diagnose allergic contact dermatitis. In this test, selected chemicals put on an adhesive strip, or “patches” and applied to the back, where there are no symptoms.

The patches are left on for 48 hours. After 48 hours, the doctor removes the patches and looks at the skin for reactions. After two more days, the doctor looks at the patch sites for signs of inflammation. If there is inflammation, the allergy to that particular chemical is confirmed.

Contact dermatitis treatment

The best treatment for contact dermatitis is avoidance of the substance that caused the reaction. Keep a careful record of when a CD flare-up happens and what products you were using prior to the outbreak. Read labels for common irritants and eliminate those from your household. Look for items with the NEA Seal of Acceptance™ as these have been created for sensitive skin.

If the contact symptoms persist, your health care provider may prescribe a topical medication or phototherapy to calm the inflammation.

Some providers who often treat contact dermatitis subscribe to electronic programs that create shopping lists for people with allergies, such as the Contact Allergen Management Program (CAMP) and the Contact Allergen Replacement Database (CARD). Ask your health care provider if they subscribe.

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Stasis dermatitis is also called gravitational dermatitis, venous eczema, and venous stasis dermatitis. It happens when there is a problem with circulation in the veins, generally in the lower legs. These problem veins cause pressure to build up as the blood tries to flow upward through the body and heart. This pressure makes fluid leak out of the veins and into the skin.

Symptoms of stasis dermatitis (venous eczema, gravitational dermatitis) include:

• Swelling, especially around the ankles that goes away while sleeping but returns in the day
• Redness
• Discolored skin
• Scaling and dryness
• Itch
• Varicose veins
• Leg ache

In severe cases of stasis dermatitis (venous eczema, gravitational dermatitis), there can be:

• Oozing
• Open areas (cracking or larger ulcers)
• Infection
• Shiny skin
• Scars where ulcers healed
• Infection, most notably, cellulitis

Over time, recurrent stasis dermatitis (venous eczema, gravitational dermatitis) can result in more permanent changes in the skin including:

• Lipodermatosclerosis: scar-like changes in the fat and other soft tissues
• Atrophie blanche: white scars surrounded by tiny capillaries
• Lichenification: thickened skin due to chronic scratching or rubbing

People with stasis dermatitis are at increased risk of developing contact dermatitis.

What causes stasis dermatitis (venous eczema, gravitational dermatitis)?

Long-standing stasis dermatitis and varicose veins associated with swelling and inflammation in the skin. Stasis dermatitis affects people with poor circulation. It usually affects people over the age of 50. Women are more likely to get it than men.

There are a number of conditions that can increase your risk for developing stasis dermatitis. These include:

• High blood pressure
• Varicose veins
• Congestive heart failure
• Kidney failure
• Obesity
• Many pregnancies
• Blood clots in leg veins

Stasis dermatitis treatment

Because the problem starts with poor circulation, your doctor may recommend treating the damaged veins in your legs by surgery. However, sometimes the surgery for the veins is not possible, or is not able to repair the veins completely.

Pressure stockings or wraps can be used to help mechanically move the fluid out of the skin and soft tissues. Elevating the legs at heart level once every two hours for 15 minutes and while you are sleeping will also help with swelling. For open sores or skin ulcers, a special dressing may need to be applied to promote healing.

Like in other forms of eczema, a topical steroid can help calm the inflammation and itch. Sometimes covering the steroid with wet or dry wrap or an Unna boot can greatly assist in severe cases. An Unna boot is a type of gauze bandage with healing medications in it and provides compression to help with fluid build up.

In cases where corticosteroids are not appropriate, or when they have been used for a prolonged period, a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed. The provider may also review medications that are known to have edema (swelling from fluidStasis Dermatitus in the tissues) as a side effect, which can contribute to stasis dermatitis.

Stasis dermatitis tends (venous eczema, gravitational dermatitis) to come back until the underlying cause (damaged veins) is addressed.

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Atopic dermatitis, also known as eczema, is a non-contagious inflammatory skin condition. It is a chronic disease characterized by dry, itchy skin that can weep clear fluid when scratched. People with eczema also may be particularly susceptible to bacterial, viral, and fungal skin infections.

A note to patients or parents seeking help and advice for themselves or their children. Our Medika Forum will offer a broad range of advice on Eczema. It’s free to use, but you’ll need to register for a free account first on Medika. Please, please keep the following in mind when dealing with eczema.

Five different eczema patients can present with identical rashes and each may have a different underlying cause for the rash. It could be stress, diet, allergies, environmental irritants, or other medical conditions. For this reason, there is no cure-all for Eczema, don’t pin your hopes on a product simply because it’s helped another person. It may work for you or it may not.

Possibly the best advice we can offer you is that you identify, if you can, the underlying cause for the rash. It can help you avoid the irritant if it ingested or environmental. It also means narrowing down the treatments that may or may not work for you. Some hit it lucky after two treatments, others struggle through twenty, and yet others find that their skin develops a resistance to a product that was helping. To assist with this there are links in the article below to proper exclusion diets and advice and information.

Eczema can be one of the most frustrating conditions to deal with. It requires patience and empathy, particularly when you’re dealing with children. It’s one of the reasons we use the Forum to allow people to interact with fellow sufferers, both for support and for sharing advice. This page is a good starting point if you’re just starting to learn about eczema. We’ve linked to a few resources on Medika that we have created in an effort to help you resolve your condition or at least, live comfortably with it.

Causes & Strategies for Prevention

A combination of genetic and environmental factors appears to be involved in the development of eczema. The condition often is associated with other allergic diseases such as asthma, hay fever, and food allergy. Children whose parents have asthma and allergies are more likely to develop atopic dermatitis than children of parents without allergic diseases.

Approximately 30 percent of children with atopic dermatitis have food allergies, and many develop asthma or respiratory allergies. People who live in cities or drier climates also appear more likely to develop the disease.

The condition tends to worsen when a person is exposed to certain triggers, such as

• Pollen, mold, dust mites, animals, and certain foods (for allergic individuals) 
• Cold and dry air 
• Colds or the flu 
• Skin contact with irritating chemicals 
• Skin contact with rough materials such as wool 
• Emotional factors such as stress 
• Fragrances or dyes added to skin lotions or soaps.

Taking too many baths or showers and not moisturizing the skin properly afterward may also make eczema worse.

Skin Care at Home

You and your doctor should discuss the best treatment plan and medications for your atopic dermatitis. But taking care of your skin at home may reduce the need for prescription medications. Some recommendations include 

• Avoid scratching the rash or skin. 
• Relieve the itch by using a moisturizer or topical steroids. Take antihistamines to reduce severe itching. 
• Keep your fingernails cut short. Consider light gloves if nighttime scratching is a problem. 
• Lubricate or moisturize the skin two to three times a day using ointments such as petroleum jelly. Moisturizers should be free of alcohol, scents, dyes, fragrances, and other skin-irritating chemicals. A humidifier in the home also can help. 
• Avoid anything that worsens symptoms, including 
  • Irritants such as wool and lanolin (an oily substance derived from sheep wool used in some moisturizers and cosmetics) 
  • Strong soaps or detergents 
  • Sudden changes in body temperature and stress, which may cause sweating 
• When washing or bathing 
  • Keep water contact as brief as possible and use gentle body washes and cleansers instead of regular soaps. Lukewarm baths are better than long, hot baths. 
  • Do not scrub or dry the skin too hard or for too long. 
  • After bathing, apply lubricating ointments to damp skin. This will help trap moisture in the skin. 

These Eczema resources may be of benefit to you

• The Different Types of Eczema
• Exclusion Diets – Identifying Allergens
• RAST Allergy Testing
• Skin Patch and Skin Prick Allergy Testing
• Avoiding Environmental Irritants
• Eczema and Stress
• Steroid Creams and Skin Care
• Alternate Health treatments for Eczema
• Epipen® and why carrying one may save your life.
• Wet Wrap Therapy for Eczema
• Which Doctors are best trained to deal with Eczema?
• Cycling Eczema Treatments
• The truth about Water and your Skin

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