Successful Treatment of Severe Nummular Eczema of Fingers with Coix-seed Reactive Derivatives (CRD): A Case Report / 日本補完代替医療学会誌

In this report, we presented the case of a 52-year-old woman who developed intractable nummular eczema of fingers for over 5 years. Coix-seed Reactive Derivatives(CRD) was administrated orally 2.2 g twice a day for 6 months. The lesions cured markedly within one month. Although CRD intake seemed to be effective in this case, further studies are needed to define the optimal dose of this food.

Dermatitis numular: presentación de dos casos pediátricos / Nummular dermatitis: report of two cases in children

La dermatitis o eccema numular es una patología poco frecuente en pediatría. El cuadro se caracteriza por un inicio con diminutas pápulas y vesículas eritematovioláceas que confluyen en placas exudativas de forma circular y evolucionan a placas eccematosas o liquenificadas de forma discoide o anular. Aparecen, predominantemente, en superficies extensoras de las extremidades, aunque pueden encontrarse en el tronco, las manos o los pies. El diagnóstico es clínico; solo en casos con mala evolución pueden ser necesarias pruebas complementarias. La base del tratamiento son los corticoides tópicos y, si se encuentra un desencadenante infeccioso, el tratamiento de la causa. Su evolución suele ser crónica o recidivante. Se presentan dos casos clínicos en población pediátrica con la finalidad de difundir entre los pediatras su conocimiento y manejo.

Nummular eczema or dermatitis is an uncommon paediatric pathology. It is presented as red-purplish small papules and vesicles that join to form exudative circular patches and then to eczematous or lichenified patches with discoid shape. The lesions appear predominantly on the extensor surface of extremities, although they can appear in trunk, hands or feet. This pathology has a clinical diagnosis; only few cases require complementary test. The topical corticosteroids are the mainstay of the treatment, and the causal treatment whether an infectious trigger is found. The patients have chronic or recurrent evolution. We report two cases in children with the aim of spreading knowledge among pediatricians.

Patch Testing in Nummular Eczema: Comparison of Patch Test Resultsbetween Nummular Eczema and Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Nummular eczema, which is also known as discoid eczema, is defined by its clinical appearance as coin-shaped, circular, or oval lesions with a definite border. The etiology of nummular eczema is obscure, and many causative factors have been proposed, but there are only a few studies of the relevance of contact allergy in nummular eczema in Korea. OBJECTIVE: The purpose of this study was to investigate the role of allergic contact dermatitis in nummular eczema patients compared with atopic dermatitis. METHODS: A total of 86 patients were enrolled in this study. Patients combined with atopic dermatitis and nummular eczema were classed as atopic dermatitis. The group with atopic dermatitis was 32 patients. The group with nummular eczema was 54 patients. We performed patch tests on both groups, and evaluated their clinical features and the results of the patch testing. RESULTS: The patients comprised of 49 males and 37 females. The mean age of group with atopic dermatitis was 21.3 years, and the mean age of group with nummular eczema was 44.2 years. The distribution by age was most prevalent at 10~19 years for the group with atopic dermatitis group and 40~49 years for the group with nummular eczema. The predominant sites of the lesions were the arms (21.0%), trunk (21.0%), legs (16.3%), widespread on the body (15.1%), hands (13.9%), feet (7.0%), face and neck (5.8%). Sixty seven (77.9%) out of 86 patients showed a positive reaction to one or more allergens. The highest sensitization rates were found with: nickel sulphate (45.3%), cobalt chloride (29.1%), potassium dichromate (20.9%), thimerosal (17.4%), neomycin sulphate (15.1%), thiuram mix (14.0%), formaldehyde (14.0%), colophony (12.8%), 4-phenylenediamine mix (11.6%), fragrance mix (10.5%). Comparing the atopic dermatitis and nummular eczema groups, there was no significant difference in the positivity for patch test allergens and frequent antigens. Comparing with clinical manifestation between the group with positive reaction and the group with negative reaction to the patch test in nummular eczema and atopic dermatitis, in the group with positive reaction of patch test, the severity of disease increased. CONCLUSION: This study shows that contact sensitivity is relatively common both with nummular eczema and atopic dermatitis. But, when there is no difference in the positive rate of antigens in patch test, both groups show high positive rate of metal antigens. Also nummular eczema patients with consistent and recurrent symptoms, the possibility of allergic contact dermatitis should be taken into consideration and a patch test must be performed.

Clinical Study on Nummula Eczema / 대한피부과학회지

BACKGROUND: Nummular eczema, known as nummular dermatitis or discoid eczema, is an idiopathic disease that manifests coin-shaped, circular, or oval-shaped plaques with definite margins. These plaques can be exudative, erythematous, or edematous. The plaques are composed of tiny vesicles in the early stage, and later tend to be more scaly, dry, lichenified and thickened. It is a chronic condition which exhibits long periods of recurrence and relapse, plus changes depending on environmental conditions. For example, it is known that the eczema worsens in low humidity, or during winter. OBJECTIVE: Since there has been an absence of studies conducted since the 1970's, we investigated epidemiology, etiology, aggravation factors, family and past history, associated diseases such as atopic dermatitis, clinical menifestations, laboratory abnormalities, and course and prognosis with statistical analysis. METHOD: A total of 211 individuals, who had visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea between 2000-2004 with a diagnosis of nummular eczema, were selected. The data was based on a retrospective survey of hospital records. However, whenever the information was lacking, we called patients to ask lists of questions for this investigation. To clarify the prognosis and course of nummular dermatitis, we classified the course of the disease into 5 groups; "healed" (cleared completely), "almost healed" (more than 90% cleared), "improved" (from 50 to 90% cleared), "stationary" (less than 50% improvement), and "wax & waned" (repetitive recurrence). RESULTS: The male to female distribution showed about a 1.4-fold predominance for males. The onset of the disease in patients was often in their twenties, which correlated with previous reports which noted that onset of lesions in patients occurred in their twenties and sixties. Nummular eczema was most frequently aggravated in summer. Thirty five of the 211 patients had atopic dermatitis, and 53 had dry skin. Thirty five of 103 patients showed an elevated serum Ig E level (more than 250 IU/ml). Seventeen of 120 patients had an elevated eosiophil count (more than 7%). If the patients had had the eczema for a short duration, these seemed to be a better chance of the condition healing. CONCLUSION: This investigation is expected to help understand and obtain more information on nummular eczema.