Nummular Eczema: What's the Best Rx?

Intense pruritus centered around a sparse “rash” sent a 32-year-old Chinese man for medical evaluation. The patient’s medical and social histories were unremarkable. Dr Ted Rosen, of Houston, noted a dozen, widely scattered, erythematous,3- to 4-cm, crusted plaques on the patient. Also present were several coin-shaped, erythematous lesions made up of vesicles and papules that oozed serous fluid. Based on the clinical presentation, nummular eczema was diagnosed. If necessary, a biopsy can confirm the diagnosis. Because of the small number of lesions, Dr Rosen prescribed the topical therapy pimecrolimus 1% cream to be applied twice daily. This preparation is indicated for the treatment of atopic dermatitis, a related subtype of eczema. The rash cleared and the pruritus resolved after 4 weeks. The patient was advised to keep the cream on hand and use it if new lesions develop in the future.