(Alternative Names: Nummular Eczema, Nummular Dermatitis, Discoid Dermatitis, Orbicular Eczema; nummular meaning coin and discoid meaning disc shaped)
Eczema is a broad term used to describe redness, swelling, pain, and increased warmth of superficial layers of skin. Usually eczemas are itchy but these may or may not be dry. Discoid or Nummular eczema is a long duration variety of eczema in which initial lesions are coin or disc shaped having alternate cycles of healing and activity.
Discoid Eczema is distinct as it arises without a known cause, runs a prolonged course, and has no permanent cure. However, it responds favorably to simple measures and most patients can help themselves to a great extent with adequate knowledge and support.
· DE has a global distribution
· It is rare in children
· Most cases of DE arise in men past 50 years followed by young women in early adulthood
· The disease cannot be passed on from parents to children
· DE is not infectious but it can spread to other areas in the same individual
· It has no known cause but certain conditions like dry skin, injuries, contact allergy, alcoholism, and presence of other skin diseases play a role in some cases
· It does not involve face and scalp
· DE cannot be cured but it is possible to control its intensity during relapses and to induce longer lasting remissions
Features, Self Help, & Preventive Measures
Discoid Eczema manifests initially as round or oval patches on the trunk and limbs that usually have the size of a coin and are studded with small bumps with variable scaling or oozing. The intensity of itching in patches is variable. Early lesions of DE might appear on one side of the body but they often involve the other side of body and show tendency to enlarge, merge, or even show central clearing. The areas in between the lesions have a normal looking skin. These lesions may show recovery which is often followed by reactivation. Laboratory investigations are not generally required except to rule out certain conditions and to assess health status in general.
Tap water compresses are helpful in most cases. Compression is done by using a moistened cloth kept over lesions for 15-20 minutes three to four times daily after squeezing out excess moisture. Emollients are quite effective for relief in active disease. Usefulness of emollients extends beyond the period of activity to later when they help in prevention. When the lesions are active, emollients can be used every two to three hours in liberal quantity. Emollients are applied gently to cover the area without rubbing and are best applied in the direction of hair growth. To enhance their efficacy, emollients may be used just after a bath or compresses. Another way to make them work even better is to cover the skin for some hours with occlusive dressing after applying the emollient or an emollient containing medication. Steroids are effective in discoid eczema but these should be used only under supervision and for specified duration only. Immunomodulators alter our body’s response to the disease. Externally used Immunomodulators have been successful in helping patients of DE. Other treatments include Ultraviolet light, immunosuppressant drugs, and biological agents.
Effective measures are available to help cope better with active phase and prolong period in between two episodes of Discoid Eczema. Most such measures can be adopted by any one.
1. Consider quitting alcohol.
2. You can observe and attempt to pinpoint any triggers like injury, insect bites, and other skin conditions that might be playing a role in precipitating relapses. Once identified, suitable action can be taken to control them.
3. You should pay attention to blood circulation in your limbs.
4. You can fare better if you maintain a good personal hygiene.
5. Keep your skin adequately moisturized. If a moisturizer is not available, you can consider using lukewarm water with or without compresses.
6. Contact your health service provider at the first signs of a recurrence as you might need medicines essential to control the disease that are not available without prescription.
7. Do not use harsh detergents and soaps.
8. Always keep your hands clean and fingernails short.
9. You might consider joining a support group.
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Dr Vinay Kumar
Senior Consultant Dermatologist
+91-93 199 299 00
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