Management of Nummular Eczema
Topical Corticosteroid Therapy
- The American Academy of Dermatology recommends applying high-potency or ultra-high potency topical corticosteroids 2-3 times daily to the affected areas, as first-line treatment for nummular eczema flare-ups, combined with aggressive emollient therapy is not cited, however, liberal and frequent application of emollients is mandatory and should be continued even after lesions appear controlled 1
- Apply emollients immediately after bathing to provide a surface lipid film that retards water loss 1
Emollient Therapy and Skin Care
- Use soap-free cleansers and avoid hot water baths, as these remove natural skin lipids and are common aggravating factors 2
Managing Pruritus
- Sedating antihistamines, such as diphenhydramine, should be prescribed exclusively at nighttime to help patients sleep through severe itching episodes 1, 2
- Large doses of sedating antihistamines may be required in children to achieve adequate symptom control 3
Identifying and Treating Secondary Infection
- Watch for increased crusting, weeping, or pustules—these indicate secondary bacterial infection requiring oral antibiotics 1, 2
- Flucloxacillin is the first-line oral antibiotic for Staphylococcus aureus, the most common pathogen 1, 2
Preventing Relapse After Clearing
- After achieving clearance, implement proactive (weekend) therapy with topical corticosteroids applied twice weekly to previously affected sites 4
- Continue aggressive emollient use daily, even when skin appears clear 1
Common Pitfalls to Avoid
- Do not delay or withhold topical corticosteroids when infection is present—they remain the primary treatment when appropriate systemic antibiotics are given 1
- Avoid using continuous topical corticosteroids without breaks—implement "steroid holidays" when possible to minimize side effects 1, 3