Nummular dermatitis in Adult
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Synopsis

Nummular dermatitis (nummular eczema) is a particular form of dermatitis characterized by pruritic, coin-shaped, scaly plaques. It is of uncertain etiology, but the onset is associated with triggers such as frequent bathing, low humidity, irritating and drying soaps, skin trauma, interferon therapy for hepatitis C, and exposure to irritating fabrics such as wool. Venous stasis may be a predisposing factor to developing lesions on the legs. Many authorities consider it to be a form of eczema, and some patients often have some of the signs and symptoms associated with classic atopic dermatitis. However, a majority of individuals with nummular dermatitis do not have a personal or family history of atopy. Infectious etiologies, particularly respiratory and dental infections, have been investigated but this association remains unclear. Ultimately, the etiology of nummular dermatitis remains incompletely elucidated.
Nummular dermatitis is pruritic but may be less pruritic than other common diagnoses with scaly plaques (eg, tinea). Autoeczematization (widespread eczematous eruption secondary to triggers such as infection or severe localized eczema) and impetiginization (superinfection of impaired skin barrier) may be seen. Nummular dermatitis is most common in men, and the peak age of incidence is between 50 and 65 years. The second most common age range of incidence is 15-25 years.
Nummular dermatitis is pruritic but may be less pruritic than other common diagnoses with scaly plaques (eg, tinea). Autoeczematization (widespread eczematous eruption secondary to triggers such as infection or severe localized eczema) and impetiginization (superinfection of impaired skin barrier) may be seen. Nummular dermatitis is most common in men, and the peak age of incidence is between 50 and 65 years. The second most common age range of incidence is 15-25 years.
Codes
ICD10CM:
L30.0 – Nummular dermatitis
SNOMEDCT:
81418003 – Nummular dermatitis
L30.0 – Nummular dermatitis
SNOMEDCT:
81418003 – Nummular dermatitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Allergic contact dermatitis
- Irritant contact dermatitis
- Tinea corporis
- Psoriasis
- Pityriasis rosea
- Seborrheic dermatitis – The distribution of lesions is often a helpful clue in distinguishing this entity from atopic dermatitis.
- Majocchi granuloma
- Lichen simplex chronicus
- Ichthyosis vulgaris
- Small plaque parapsoriasis
- Pityriasis rubra pilaris
- Secondary syphilis
- Pellagra
- Mycosis fungoides
- Glucagonoma syndrome
- Eczema craquele
- Crusted scabies (with severe immunosuppression)
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:01/31/2017
Last Updated:03/28/2017
Last Updated:03/28/2017

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