Nummular eczema: symptoms, causes & treatment

Nummular eczema is a chronic form of eczema characterized by round, minty patches of skin. The name comes from the Latin nummus (coin), because the lesions have the same round shape as a coin. The condition is also known as nummular dermatitis, or sometimes infectious eczema, although the latter name is misleading because an infection has nothing to do with it.

Nummular eczema occurs mainly in adults between 40 and 60 years of age. Men experience this form of eczema slightly more often than women. Younger adults can also get it, but that is less common.

The exact cause has not yet been fully clarified. Heredity certainly plays a role. If eczema runs in your family, you're more likely to get it too. People with a predisposition to dry skin or allergic diseases such as hay fever are also at increased risk.

It is a chronic condition that lasts for a long time and cannot be cured permanently. The symptoms often come in flares, with periods in which things are getting better alternated with periods where the symptoms flare up.

In eczema, the skin's natural barrier function is disrupted. Normally, your skin has a protective layer that protects you against external stimuli. In people with eczema, this layer is not formed properly, causing the skin to dry out more quickly and become more sensitive.

Although the exact cause is not known yet, we do know that several factors contribute to the development and worsening of the condition.

Heredity is an important factor. If one or both parents have had eczema, their children are more likely to develop eczema as well. This does not mean that you will definitely get it, but it does mean that you are predisposed to sensitive skin.

Dry skin is the breeding ground for nummular eczema. When your skin does not retain enough moisture, the barrier function weakens and the skin can be damaged more easily.

Too much soap washing is a common culprit. Soap degreases the skin, which leads to extreme dryness and irritation for sensitive people. Strong soaps or perfumed soaps are particularly problematic.

Stress is often mentioned as a trigger. Although the mechanism is not entirely clear, stress can affect the immune system and aggravate inflammatory processes.

Clothing also plays a role. Rough, abrasive, or itchy materials can irritate the skin. Too warm, tight clothing that causes excessive sweating is also problematic, because sweating irritates sensitive skin.

A smoky environment can make nummular eczema worse. Tobacco smoke contains irritants that can irritate the skin. Passive smoking therefore also has a negative influence.

The climate has a major influence. The condition often worsens during the winter months because the air is drier, both outside due to the cold and inside because of the heating. Things often get better in the summer. Sunlight has a beneficial effect on many forms of eczema.

Allergies can make nummular eczema worse. Contact allergies, where you react to substances that touch your skin, can cause eczema patches. Food allergies also play a role for some.

Nummular eczema often develops as a combination of these factors. Someone with a genetic predisposition and dry skin can remain symptom-free for years, until stress coincides with dry winter air and frequent soap use.

Nummular eczema has a characteristic appearance that distinguishes it from other forms of eczema. The most prominent feature is the rounded or oval-shaped spots that are sharply delineated. This coin-like shape is so typical that doctors can often make the diagnosis just by looking at the appearance.

The condition usually starts with a single blister or small spot. Several new lesions soon appear around this first spot. These tiny blisters grow and coalesce into larger, rounded, or oval-shaped patches.

The color is often red to bright red due to the inflammatory response. The intensity ranges from light pink in mild inflammation to deep red with more severe outbreaks.

Peeling is another important feature. The skin on the eczema patches is often dry and flakes off in small white flakes. This is because the skin cells renew themselves more quickly in response to inflammation.

Moisture mainly occurs in active, fresh eczema areas. The spots may be wet, with clear moisture seeping out. Over time, they dry up and become scaly.

The itch is perhaps the most annoying symptom. The itching can be intense and is often worst in the evening and night, which can affect your sleep. Scratching provides temporary relief, but further damages the skin and worsens inflammation. This creates a vicious cycle.

The size varies greatly. Some spots are only a few centimetres in diameter, others can grow up to five to ten centimetres. They are usually between two and five centimeters tall.

The number of places varies from person to person. Some have only one or two spots, others dozens scattered around their bodies.

An important characteristic is the chronic nature with flare-ups. The spots can remain in place for weeks to months. Sometimes they disappear altogether, but often they come back later. These recurrent outbreaks make nummular eczema persistent.

Nummular eczema can occur in various parts of the body, and observations show that certain locations may be affected more frequently than others.

The lower legs, thighs, and arms appear to be relatively frequent locations. In a number of people, the condition starts with patches on one lower leg, often at the front. It could be that the skin on the lower legs is naturally drier, which may make this location more sensitive. The front and back of the thighs can also be affected, as well as the lower and upper arms.

The back, abdomen and chest may also be affected. Spots on the back are sometimes difficult to treat yourself. Spots in the knee creases, around the elbows, wrists and ankles are also sometimes seen, possibly because clothing or jewelry makes contact with the skin here or because the skin folds here.

Nummular eczema appears to be less common in the face. The hands and feet also often seem to be spared, although exceptions are possible. The distribution can be symmetrical - sometimes spots occur in similar places on both halves of the body. For some, the spaces remain limited; for others, they can expand.

The treatment focuses on reducing the inflammatory response, relieving itching and restoring barrier function. Because the condition is chronic, treatment is mainly about good, long-term skin care.

Skin care forms the basis. Applying a greasy cream or ointment daily is essential. These products help retain moisture and restore barrier function. Lubricate your entire body, not just the eczema areas. The best time is right after showering, when your skin is still damp. Creams contain more water and are lighter, ointments are heavier and fatter. For nummular eczema, the oilier products often work best. Bath oil can be a good addition to creams.

A crucial rule of thumb: don't use too much soap. Soap degreases the skin and worsens dryness. Limit soap to armpits and groin, continue showering with water, or use mild, soap-free wash gel or oil. It is also important not to shower too long or too hot. Five minutes of lukewarm water is better than ten minutes of hot water.

For active eczema patches that don't respond to skin care alone, your doctor may prescribe a corticosteroid cream. These anti-inflammatory drugs help reduce redness, swelling, and itching. You only apply them to the eczema areas. You usually use them once or twice a day for a limited period of time. Once the spots are gone, stop and continue with oily cream alone.

Practical measures are also important. Wear soft, airy cotton clothing. Avoid wool and raw materials. Dress in layers so it's easy to take off when you get warm. Use gloves with irritating products. Ensure good ventilation in the home, especially in the winter. Heating dries out the air. A humidifier can help. Smoking at home is an absolute no-go.

In case of persistent eczema, your doctor may refer you to a dermatologist. The skin specialist can investigate contact allergies by means of plaque tests. Light therapy with ultraviolet light may also be suggested. This usually happens two to three times a week for a few weeks to months and has an anti-inflammatory effect.

There are various misconceptions and wrong approaches that are better to avoid. Washing too much with soap is counterproductive. Although it seems logical to combat skin problems by washing extra well, this is counterproductive. Soap degreases the skin and worsens dryness.

Scratching provides temporary relief but makes the situation worse. By scratching, you further damage the skin and strengthen the inflammation. Crab wounds can also become infected. Try to relieve itching with a cold compress.

Perfume-containing products are out of the question. Perfume can trigger allergic reactions and irritate the skin. Always opt for fragrance-free products.

Neglecting skin care during quiet periods is a common mistake. Even if your skin looks good, you should continue to apply it daily. Good skin care is often a lifelong necessity.

Stopping cortisone ointment too early can lead to rapid relapses. Always complete the treatment as prescribed. At the same time, long-term use is not advisable due to possible side effects.

Miracle remedies that claim to cure eczema permanently cannot be trusted. Nummular eczema is chronic and has no cure. Such products are often a waste of money.

Ignoring triggers is counterproductive. If you notice that certain things make your eczema worse, it's important to identify and avoid them. Keeping an eczema book can help you discover patterns.

Is nummular eczema contagious?

No, definitely not. Although the condition is sometimes referred to as infectious eczema, it is misleading. You can't catch it through contact. It's an inflammatory response from your own skin, not an infection.

Can nummular eczema completely heal?

Nummular eczema is chronic and cannot be cured permanently. The spots may disappear with treatment, but the predisposition remains. Outbreaks can come back, especially with triggers or neglect of skin care. With good care, people can remain complaint-free for years.

Why does my eczema get worse in the winter?

The dry winter air is the biggest culprit. Outside, the air is colder and drier; inside, heating provides even drier air. This dryness draws moisture out of your skin. Extra intensive skin care in winter is essential.

Can I go out in the sun with nummular eczema?

Yes, sunlight can even be beneficial. UV radiation has a mild anti-inflammatory effect. However, it is important to prevent combustion. Summer is often a quiet period for people with nummular eczema.

Do I have to follow a special diet?

There is no general diet that helps. For some, specific foods can trigger flare-ups, but this is very individual. If you suspect that food plays a role, discuss this with your doctor. Allergy research may be able to provide an answer.

How long does a surge last?

The duration varies greatly. With good treatment, spots can disappear within a few weeks. Without treatment or in case of persistent forms, spots can remain present for months. Early treatment and consistent skin care help to keep flares shorter.

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