Nummular Eczema

September 14, 2005
D. Keith Cobb, MD

Enlarging, coin-shaped lesions erupted on a 54-year-old man's posterior hands, arms, and buttocks 3 weeks before he sought medical evaluation. A few scattered lesions arose on his trunk and thighs as well. The lesions were mildly pruritic, but there were no excoriations. No discharge from the lesions was observed. The patient's history revealed no causative environmental factors.

Enlarging, coin-shaped lesions erupted on a 54-year-old man's posterior hands, arms, and buttocks 3 weeks before he sought medical evaluation. A few scattered lesions arose on his trunk and thighs as well. The lesions were mildly pruritic, but there were no excoriations. No discharge from the lesions was observed. The patient's history revealed no causative environmental factors. Dr D. Keith Cobb of Richmond Hill, Ga, writes that the clinical impression of nummular eczema was confirmed by a biopsy of one of the lesions on the patient's left arm (A).

Nummular eczema is a common disorder that features coin-shaped plaques which vary in size from 1 to 5 cm. Usually, the lesions are round, scaly, superficial and, occasionally, confluent, as in this patient. Frequently, the plaques are pruritic; subsequent excoriations may become secondarily infected.

In this patient, the hypertrophy and scaling improved dramatically after a course of topical corticosteroids (B). Topical corticosteroids are indicated because discontinuation of oral agents can cause the condition to flare.