Eczema Club: All About Eczema: Eczema Treatments for Nummular Eczema

Nummular eczema usually appears on the arms and legs. Red, scaly, coin-shaped patches characterize nummular eczema. The disorder's name comes from nummus, the Latin name for 'coin.'

As the condition clears, the patches heal from the inside skin layers to the outer layer, the healing lesions resemble red rings, thus accounting for the disorder's other name, discoid eczema.

Discoid eczema is associated with the winter season, conditions of low humidity, and dry skin.

Some Eczema Medications and Treatments

(1) Halcinonide cream (Halog) is a medium-high potency corticosteroid cream, which was found to be effective in a study of 101 patients with moderate-severe skin conditions, including nummular eczema.

Halcinonide cream was prescribed twice or three times a day for three weeks, and patients were followed-up weekly during this period.

Sixteen patients stopped treatment after two weeks because their lesions had cleared. By the end of three weeks, the condition in 46 of the patients had completely resolved, the condition in 39 showed marked improvement, the condition in 10 had improved moderately, the condition in 5 showed mild improvement, and the condition in 1 did not show any improvement. No local or systemic side effects were reported.

I also found a number of papers about the beneficial effects of halometasone cream and ointment. This is a another medium-high potency corticosteroid preparation similar to halcinonide, but it is not available in the USA.

(2) Doxepin cream, applied 4 times daily, was found useful in a group of 309 patients, including 87 with nummular eczema, with 60% experiencing relief from itching within 24 hr and 84% by the end of the 7-day study.

Some patients with various types of eczema, including nummular eczema, were found to experience a worsening of symptoms when they were challenged orally with salts of chromium, cobalt or nickel. Some of these patients experienced improvement after following a diet low in
metal for at least four weeks.

(3) There are some reports on the improvement caused in some eczema patients by a low nickel / chromium / cobalt diet.

One concludes: “These research papers indicate that eczema sufferers may be helped by avoiding the main food groups which tend to be high in nickel - chocolate, nuts, beans, porridge oats - and that an allergy test or food elimination diet are worth considering to help overcome the condition.”

The problem with a low chromium diet is that it can cause other problems, because chromium is important in the functioning of insulin in the body. The sources of chromium in the diet are: “brewer's yeast, lean meats (especially processed meats), cheeses, pork kidney, whole-grain breads and cereals, molasses, spices, and some bran cereals. Brewer's yeast grown in chromium-rich soil is the best dietary source for chromium. Vegetables, fruits, and most refined and processed foods (except for some processed meats, which contain high amounts of chromium) contain low amounts of chromium. Hard tap water can supply 1 to 70% of your daily requirement.

In another paper, low cobalt and low nickel diets do not get approval from the author: “For nickel-sensitive patients, diets that avoid foods rich in nickel, such as canned foods, foods that are
cooked with nickel-plated utensils, herring, oysters, asparagus, beans, mushrooms, onions, corn, and spinach. Such restrictions are difficult for patients to follow and only rarely successful. For
cobalt-sensitive patients, a low-cobalt diet, which avoids apricots, beans, beer, beets, cabbage, chocolate, cloves, cocoa, coffee, liver, nuts, scallops, tea, and whole grain flour. This measure is also therapeutically unrealistic.”

If you do want to consider the diet route, it would be useful to establish first whether you do suffer a flare-up to any of these metals.

(4) The NCERx site mentioned above also gives some general advice on
prevention and treatment of eczema, which is applicable to all types.

Preventions:

Take quick lukewarm showers rather than long hot baths. If you want to have a bath, use lukewarm water and do not stay inside for more than 10-20 minutes. “Avoid using soaps: even a mild soap can dry and irritate skin. When you dry after a shower, pat yourself dry: rubbing can do as much damage to your skin as scratching. Once dry, moisturize with a gentle cream, ointment, or lotion.”
Things that cause allergies can trigger eczema and itching, so the recommendation is to avoid known allergens, including dust mites, pet dander, perfumes and soaps. “The best strategies to minimize contact with dust mites are washing clothing and bed linens and vacuuming on a regular basis.
Pillow and mattress wraps also help reduce contact with mites. Some people replace carpet with linoleum, wood or other flooring, as carpets tend to harbor large numbers of dust mites.”
Excessive sweating can make eczema worse, so losing weight can help, but do avoid exercise programs that cause profuse sweating and wear soft absorbent clothes during exercise.
Do avoid scratching the itchy bits!
Laundry soap can leave residue on clothes that aggravates eczema. Look for laundry soap designed for sensitive skin. Some people prefer to use baking soda to wash their clothes. Whether using a gentle laundry soap or baking soda, rinse clothes thoroughly to remove any residues.
If low humidity causes your skin to dry and crack, try using humidifiers in your home or office. Humidifying the air in the rooms where you spend time is a good strategy if you are prone to dry skin conditions.

Treatments:

Topical treatments, i.e. treatments applied directly to the skin startwith moisturizers, which are the most common topical treatments.

Ointments, creams and lotions can "lock" moisture in, preventing the skin from drying out and cracking.
Coal tar – a traditional remedy, which can aggravate symptoms and cause the skin the become sensitive to sunlight. It is also sticky and messy to use.
Hydrocortisone Cream – hydrocortisone,, a corticosteroid, can be useful, but may become less effective after prolonged use. In fact, long-term use is not recommended, because it can “cause thin skin,stretch marks and excess body hair.
Topical Immunomodulators: these are a new class of non-steroidal anti-inflammatory drugs, which have fewer side effects than corticosteroids, and which have been found fully or partially effective in about 80% of eczema cases. Tacrolimus is one such medication.

Oral medication is used in severe cases, or to treat complications. The substances used include:

Antibiotics: used to treat bacterial infections that can arise with eczema and worsen symptoms. However, they can have side effects.
Antihistamines: control itching, but might not be particularly effective, because histamine does not play a big part in eczema. The older types can cause drowsiness, and so should not be used while driving.
Corticosteroids: although these can be useful in severe cases, there is more chance of side effects than with hydrocortisone cream.

Therapy with ultraviolet light can reduce symptoms. The effect can be increased by using light therapy in combination with a drug called psoralen.

It is recommended keeping a food diary to see if any foods are associated with a worsening or improvement of symptoms. This really belongs to the prevention measures listed above.

One further approach, which is still controversial, is the use of Chinese herbal medicine. Some studies have found this effective in the treatment of eczema and psoriasis, while others have found no benefit. In addition, cases of toxic reactions to the medications used have
been reported. I have not found any literature on the use of Chinese herbal medicines in the treatment of nummular eczema specifically.

Reference:

http://www.ncerx.com/html/about-us.php3
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202016.html
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202751.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6627927&dopt=Abstract
http://www.internethealthlibrary.com/Health-problems/Eczema%20-%20research-nickel-000228.htm
http://www.usadrug.com/IMCAccess/ConsSupplements/Chromiumcs.shtml
http://www.womenshealthpc.com/8_01/pdf/515DermRounds.pdf
http://www.treatments-for-eczema.com/html/prevention.php3
http://www.treatments-for-eczema.com/html/eczema_treatments.php3
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500279.html

Source: http://answers.google.com/answers/threadview?id=193807

Edited for the purpose of Eczema Club blog.