A 55-Year-Old with a Recent History of Rash

Diagnosis

This patient was diagnosed with nummular dermatitis (nummular eczema). Many authorities consider it to be a form of eczema, and some patients may have signs and symptoms associated with classic atopic dermatitis. However, most individuals with nummular dermatitis do not have a personal or family history of atopy.

Learnings/What to Look for

• Nummular dermatitis is characterized by pruritic, coin-shaped, scaly plaques. However, it may be less pruritic than other common diagnoses with scaly plaques (eg, tinea)
• Autoeczematization (widespread eczematous eruption secondary to triggers such as infection or severe localized eczema) and impetiginization (superinfection of impaired skin barrier) may be seen
• While etiology has not been completely elucidated, onset is associated with triggers such as frequent bathing, low humidity, irritating and drying soaps, skin trauma, interferon therapy for hepatitis C, and exposure to irritating fabrics such as wool. Venous stasis may be a predisposing factor to developing lesions on the legs.

Pearls for Urgent Care Management

• Hypoallergenic, fragrance-free, over-the-counter creams or ointments for good skin hydration may suffice for mild cases
• Persistent or severe cases may respond to topical corticosteroids
• If a superinfection is present, topical antibiotics may help
• An astringent compress may be employed for weepy, oozy patches

Acknowledgment: Images and case presented by VisualDx (www.VisualDx.com/JUCM).