Eczema Numular

Etimology
  • Nummulus (latin) = coin
 
Etiologia
  • May be a feature of other eczema → nosologic position as independent entity has been questioned
    • Atopic dermatitis
    • Asteatotic eczema
    • Stasis dermatitis
    • Allergic contact dermatitis
      • Nickel sulfate > potassium dichromate > cobalt chloride
  • Idiopathic
    • Associated with atopy, xerosis (especially in older adults), irritant exposure, microbiome (S. aureus colonization), and infection (dental), medications (eg. interferon and ribavirin for hepatitis C)
      • Distant infection (eg. odontogenic infection) may be the cause (-id reaction)
    • No atopy in “true” nummular eczema
 
Epidemiologia
  • Men >50
  • Women <30
 
Apresentação clínica
  • Sattelite papulovesicles that coalesce
 
DDx
  • Inflammatory Tinea corporis
  • Psoríase
    • More well demarcated - may be confused with psoriasis
    • “Wetter” than psoriasis
  • Bowen
  • Mycosis fungoides
  • Syphilis
 
Exames complementares de diagnóstico
  • Testes epicutâneos
  • Exame micológico e biópsia?
  • No adulto com eczema numular de novo pedir análises (??? - fonte)
 
Tratamento
  • Corticoides
  • Inibidores da calcineurina
  • Fototerapia
  • Como xerose contribui → emoliente
  • MTX
  • Dupilumab
  • Ciclosporina
  • Saurat: antibióticos podem ser considerados