Nummular Eczema of the Extremities

An 81-year-old woman presented with a widespread pruritic eruption of 1 month's duration. She had hypertension but was otherwise healthy and was taking no new medications.

Ted Rosen, MD, of Houston noted about 2 dozen 1- to 3-cm round, crusted patches on the patient's arms and legs. No adenopathy was detected.

Histopathologic examination of a biopsy specimen revealed a perivascular and intraepidermal benign- appearing lymphocytic infiltrate, which confirmed the diagnosis of eczema. The morphology of nearly circular lesions is consistent with a specific diagnosis of nummular ("coin-shaped") eczema-a common problem among elderly persons. Although the condition typically occurs during cold weather with low humidity, in this case it first appeared during a hot, humid Gulf Coast summer. This patient had inherently dry skin.

Treatment involves application of a moisturizer, use of a detergent-free soap substitute during bathing (such as Cetaphil or Aquanil), and application of a mid-potency topical corticosteroid 1 or 2 times daily. This relatively simple and safe regimen led to almost immediate relief of pruritus and clinical clearing within 3 weeks. In some cases, the disease process remains refractory unless the patient receives a brief course of oral or intramuscular injection corticosteroids.