Medscape is available in 5 Language Editions – Choose your Edition here.


Nummular Dermatitis Follow-up

  • Author: Jami L Miller, MD; Chief Editor: William D James, MD  more...
Updated: Mar 25, 2016


Aggressive hydration of the skin may decrease the frequency between nummular dermatitis eruptions.

Bathing is permissible, but hot water should be avoided. Patients should use mild, nondrying cleansers. Patients should be encouraged to use nonsoap cleansers only for control of body odor and cleanliness (eg, on the groin, axillae, and feet). Oil additives may be used in bathing water. To avoid drying of the lesions, an emollient should be used immediately after bathing. The skin may be patted and the emollient applied before the skin is completely dry. Clothing should be loose to avoid overheating, and irritating fibers, such as wool, should be avoided.

A room humidifier is useful, particularly when a heater or air conditioning is used.



Nummular dermatitis lesions may become secondarily infected. Heavily excoriated or infected lesions may leave permanent scars. Lesions on the lower extremities take a long time to heal and may leave permanent brown macules. Cellulitis rarely occurs. Particularly pruritic cases may result in difficulty sleeping and concentrating.



Nummular eczema tends to be a chronic condition that remits and relapses. Patients need to be informed that once nummular dermatitis develops, it is often recurrent. Avoidance of exacerbating factors and close attention to moisturizing the skin may help reduce the frequency.

Pruritus, often worst at night, may cause irritability, insomnia, or both.

Secondary infection may result in lesions that ooze serosanguineous exudate. The most common organism revealed by culture is Staphylococcus aureus.

Generalized flares may require systemic antibiotics and/or systemic steroids.

Increased contact sensitivity to environmental antigens (especially metals) could limit ability to tolerate those antigens, especially clothing, metal snaps, jewelry, dental amalgams or occupational exposure.


Patient Education

Patients must be educated about the most important predisposing condition to nummular eczema—dry skin. Use of gentle soaps and copious application of moisturizers, especially while the skin is still damp after bathing, is imperative. Once the lesions develop, use of topical steroids or calcineurin inhibitors helps with the itch and hastens resolution.

For excellent patient education resources, visit eMedicineHealth's Skin Conditions and Beauty Center. Also, see eMedicineHealth's patient education article Eczema.

Contributor Information and Disclosures

Jami L Miller, MD Assistant Professor, Division of Dermatology, Department of Internal Medicine, Vanderbilt University Medical School; Director of Phototherapy Unit, Vanderbilt University Medical Center; Consulting Attending Physician, Nashville Veterans Affairs Medical Center

Jami L Miller, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

John D Wilkinson, MD, MBBS, MRCS, FRCP Chairman, Clinical Director, Department of Dermatology, Amersham Hospital and High Wycombe Hospital, UK

John D Wilkinson, MD, MBBS, MRCS, FRCP is a member of the following medical societies: American Academy of Dermatology, Royal College of Physicians

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Khristina Collins, MD, and Lloyd King, MD, to the development and writing of this article.

  1. Devergie MGA. Traite Pratique des Maladies de la Peau. 1857. 2:238.

  2. Bonamarte D, oti C, Vestita M, Ranieri LD, Angelini g. Nummular eczema and contact allergy: a retrospectove study. Dermatitis. 2012 Jul - Aug. 23(4):153-7. [Medline].

  3. Aoyama H, Tanaka M, Hara M, Tabata N, Tagami H. Nummular eczema: An addition of senile xerosis and unique cutaneous reactivities to environmental aeroallergens. Dermatology. 1999. 199(2):135-9. [Medline].

  4. Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005 Apr. 52(4):579-82. [Medline].

  5. Bonamonte D, Foti C, Vestita M, Ranieri LD, Angelini G. Nummular eczema and contact allergy: a retrospective study. Dermatitis. 2012 Jul-Aug. 23(4):153-7. [Medline].

  6. Moore MM, Elpern DJ, Carter DJ. Severe, generalized nummular eczema secondary to interferon alfa-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection. Arch Dermatol. 2004 Feb. 140(2):215-7. [Medline].

  7. Shen Y, Pielop J, Hsu S. Generalized nummular eczema secondary to peginterferon Alfa-2b and ribavirin combination therapy for hepatitis C infection. Arch Dermatol. 2005 Jan. 141(1):102-3. [Medline].

  8. Flendrie M, Vissers WH, Creemers MC, de Jong EM, van de Kerkhof PC, van Riel PL. Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther. 2005. 7(3):R666-76. [Medline].

  9. Horsmanheimo L, Harvima IT, Jarvikallio A, Harvima RJ, Naukkarinen A, Horsmanheimo M. Mast cells are one major source of interleukin-4 in atopic dermatitis. Br J Dermatol. 1994 Sep. 131(3):348-53. [Medline].

  10. Jarvikallio A, Naukkarinen A, Harvima IT, Aalto ML, Horsmanheimo M. Quantitative analysis of tryptase- and chymase-containing mast cells in atopic dermatitis and nummular eczema. Br J Dermatol. 1997 Jun. 136(6):871-7. [Medline].

  11. Jarvikallio A, Harvima IT, Naukkarinen A. Mast cells, nerves and neuropeptides in atopic dermatitis and nummular eczema. Arch Dermatol Res. 2003 Apr. 295(1):2-7. [Medline].

  12. Kim JW, Ko HC, Kim MB, Kim JM, Kim BS. Features if Staphylococcous aureus colonization in patients with nummular eczema. Br J Dermatol. 2013 Mar. 168(3):658-60. [Medline].

  13. Jiamton S, Tangjaturonrusamee C, Kulthanan K. Clinical features and aggravating factors in nummular eczema in Thais. Asian Pac J Allergy Immunol. 2013 Mar. 31 (1):36-42. [Medline].

  14. Jiamton S, Tangjaturonrusamee C, Kulthanan K. Clinical features and aggravating factors in nummular eczema in Thais. Asian Pac J Allergy Immunol. 2013 Mar. 31(1):36-42. [Medline].

  15. Patel N, Mohammadi A, Rhatigan R. A comparative analysis of mast cell quantification in five common dermatoses: lichen simplex chronicus, psoriasis, lichen planus, lupus, and insect bite/allergic contact dermatitis/nummular dermatitis. ISRN Dermatol. 2012. 2012:759630. [Medline]. [Full Text].

  16. Patrizi A, Rizzoli L, Vincenzi C, Trevisi P, Tosti A. Sensitization to thimerosal in atopic children. Contact Dermatitis. 1999 Feb. 40(2):94-7. [Medline].

  17. Pigatto PD, Guzzi G, Persichini P. Nummular lichenoid dermatitis from mercury dental amalgam. Contact Dermatitis. 2002 Jun. 46(6):355-6. [Medline].

  18. Le Coz CJ. Contact nummular (discoid) eczema from depilating cream. Contact Dermatitis. 2002 Feb. 46 (2):111-2. [Medline].

  19. Bendl BJ. Nummular eczema of statis origin. The backbone of a morphologic pattern of diverse etiology. Int J Dermatol. 1979 Mar. 18(2):129-35. [Medline].

  20. Adachi A, Horikawa T, Takashima T, Ichihashi M. Mercury-induced nummular dermatitis. J Am Acad Dermatol. 2000 Aug. 43(2 Pt 2):383-5. [Medline].

  21. Pietrzak A, Chodorowska G, Urban J, Bogucka V, Dybiec E. Cutaneous manifestation of giardiasis - case report. Ann Agric Environ Med. 2005. 12(2):299-303. [Medline].

  22. Sakurane M, Shiotani A, Furukawa F. Therapeutic effects of antibacterial treatment for intractable skin diseases in Helicobacter pylori-positive Japanese patients. J Dermatol. 2002 Jan. 29(1):23-7. [Medline].

  23. Tanaka T, Satoh T, Yokozeki H. Dental infection associated with nummular eczema as an overlooked focal infection. J Dermatol. 2009. Aug. 36(8):462-5. [Medline].

  24. Khurana S, Jain VK, Aggarwal K, Gupta S. Patch testing in discoid eczema. J Dermatol. 2002 Dec. 29(12):763-7. [Medline].

  25. Krupa Shankar DS, Shrestha S. Relevance of patch testing in patients with nummular dermatitis. Indian J Dermatol Venereol Leprol. 2005 Nov-Dec. 71(6):406-8. [Medline].

  26. Gutman AB, Kligman AM, Sciacca J, James WD. Soak and smear: a standard technique revisited. Arch Dermatol. 2005 Dec. 141(12):1556-9. [Medline].

  27. Bukhari IA. Successful treatment of chronic persistent vesicular hand dermatitis with topical pimecrolimus. Saudi Med J. 2005 Dec. 26(12):1989-91. [Medline].

  28. Gambichler T. Management of atopic dermatitis using photo(chemo)therapy. Arch Dermatol Res. 2009 Mar. 301(3):197-203. [Medline].

  29. Roberts H, Orchard D. Methotrexate is a safe and effective treatment for paediatric discoid (nummular) eczema: a case series of 25 children. Australas J Dermatol. May 2010. 51(2):128 - 130. [Medline].

Dry, scaling plaque of nummular dermatitis (size, 3 X 5 cm) on the shin.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.