Transcript Nummular Dermatitis

APPEARANCE:
• Primary lesions discrete, coin-shaped, erythematous, edematous, vesicular and
crusted patches, 20-40 mm in diameter
DISTRIBUTION:
• Begins on lower legs, dorsa of the hands, or extensor surfaces of the arms
EVOLUTION:
• As new lesions appear, old lesions expand by tiny papulovesucular (satellite
lesions) appearing at the periphery and fusing with the main plaque.
• Severe cases: palm-sized or larger patches
OTHERS:
• May form after trauma (Koebner’s phenomenon)
• Pruritus is usually severe and of the same paroxysmal, compulsive quality, and
nocturnal timing seen in circumscribed neurodermatitis
Reference:Andrew’s Diseases of the Skin: Clinical Dermatology
NUMMULAR DERMATITIS
Patient, 9 y.o.
Primary lesions discrete, coin-shaped,
erythematous, edematous, vesicular and crusted
patches
20-40 mm in diameter
papules and plaques
Begins on lower legs, dorsa of the hands, or
extensor surfaces of the arms
Mainly over the antecubital
and popliteal fossae
Infancy, lesions on the
cheeks and scalp
As new lesions appear, old lesions expand by tiny
papulovesucular (satellite lesions) appearing at the
periphery and fusing with the main plaque.
 Severe cases: palm-sized or larger patches
May form after trauma (Koebner’s phenomenon)
Pruritus is usually severe and of the same
paroxysmal, compulsive quality, and nocturnal
timing seen in circumscribed neurodermatitis
Itchy
temporarily relieved by
application of hydrocortisone
cream
Recurrent, 7 years duration
Eczematous eruption of the lower legs secondary to
peripheral venous disease
• Venous incompetence 
increased hydrostatic pressure
and capillary damage with
extravasation of red blood cells
and serum
• Incidence: a disease of adults,
predominantly of middle and old
age
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.
Eczematous eruption of the lower legs secondary to
peripheral venous disease
• History:
– Subacute or chronic, pruritic
eruption of lower legs preceded by
edema and swelling
– Have often had thrombophlebitis
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.
• Prominent varicose veins
and pitting edema
• Peripheral pulses in tact
• Involved skin has
brownish
hyperpigmentation, dull
erythema, petechiae,
thickened skin, scaling, or
weeping,
• Any portion of the lower
leg; predominant site is
above the middle
malleolus
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.
STASIS ECZEMA
Patient
Disease of adults, predominantly
•
KEYandPOINTS
middle
old age
 Subacute
and chronic dermatitis,
– Eczematous
patches
brownish hyperpigmentation, edema,
leg edema
petechiae
 Infancy to childhood (9 years old)
 Papules and
plaques
or plaques
overlying
lower
 Lower
leg, predominanty
above the
– Chronic
and itchy
medial malleolus
– Treat venous
stockings
Mainly over the antecubital and
popliteal fossae
Infancy,
on the cheeks and scalp
hypertension
withlesions
compression
Pruritic
Treatment: reduction of leg edema,
compression stockings, leg elevation, with
steroids for crusting and oozing
Itchy
Temporarily relieved by application of
hydrocortisone cream
Recurrent, 7 years duration