Nummular Eczema (discoid eczema)

Diagnosis: Nummular Eczema (discoid eczema)

Pruritic, round, coin-shaped plaques with erythema, scales, fissuring and crusts on dorsum of fingers.

Clinical Presentation

Pruritic, round, coin-shaped plaques with erythema, scales, fissuring and crusts on dorsum of fingers.

Clinical History

Submitted by Alaa Saad. Originally posted September 18, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Psoriasis • Contact dermatitis • Scabies • Tinea corporis • Seborrheic dermatitis • Mycosis fungoides • Drug eruption

Key Learnings

• "Eczema" is a clinical pattern, not a single diagnosis — encompasses multiple subtypes • Impaired skin barrier function is central to pathogenesis • Spongiosis (intercellular edema in epidermis) is the histological hallmark • Acute: vesicles, weeping. Subacute: erythema, scale. Chronic: lichenification, fissuring • Superinfection with S. aureus is common and may cause flares

Tags: nummular, eczema, discoid, alaa saad