Nummular Eczema

, Corinna Eleni Psomadakis2 and Bobby Buka3



(1)
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA

(2)
School of Medicine Imperial College London, London, UK

(3)
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA

 



Keywords
Discoid eczemaNummular eczemaDiscoid dermatitisAnnularRingContact allergyTopical corticosteroids




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Fig. 27.1
Often misdiagnosed as ringworm, this circular plaque is less pruritic and has scale throughout


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Fig. 27.2
This coin-shaped lesion has a chapped appearance and is exceedingly common


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Fig. 27.3
(a and b) Follicular prominence is the first sign of xerosis , a clue to your diagnosis


Primary Care Visit Report


A 23-year-old female with past medical history of recurrent vaginal yeast infections, treated with weekly fluconazole 100 mg, presented with a pruritic rash. The rash started 2 weeks prior to this visit, with lesions on her right cheek (mostly resolved at visit), two round lesions on her right upper arm, a single lesion on her left shoulder area, and a rash on her upper thighs and abdomen. All lesions were pruritic and the patient reported a “burning, irritated” feeling on her legs. She had started using Tom’s soap for the first time about 1 month prior. Otherwise, no new skin products were reported.

Vitals were normal. On exam, there was a 5 mm × 5 mm round papular lesion with hyperpigmented border on her right upper arm, and a 1 cm × 1 cm scaly dry plaque with central clearing on her left upper arm. Her abdomen and bilateral thighs featured rough, papular, scaly dry plaques.

The considered differential was eczema versus a fungal infection. The patient was initially treated for eczema, and was prescribed topical desonide 0.05 % cream (Class VI) twice daily for 14 days. The patient was advised to discontinue use if the rash was not resolving with desonide, and instead try clotrimazole 1 % cream twice daily.


Discussion from Dermatology Clinic



Differential Dx


Jun 29, 2017 | Posted by in Uncategorized | Comments Off on Nummular Eczema
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