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.

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.