1. Nummular Dermatitis
Primary lesions discrete, coin-shaped, erythematous, edematous, vesicular and crusted patches, mm in diameter
APPEARANCE:
Begins on lower legs, dorsa of the hands, or extensor surfaces of the arms
DISTRIBUTION:
As new lesions appear, old lesions expand by tiny papulovesucular (satellite lesions) appearing at the periphery and fusing with the main plaque.
Severe cases: palm-sized or larger patches
EVOLUTION:
May form after trauma (Koebner’s phenomenon)
Pruritus is usually severe and of the same paroxysmal, compulsive quality, and nocturnal timing seen in circumscribed neurodermatitis
OTHERS:
Reference:Andrew’s Diseases of the Skin: Clinical Dermatology

2. Nummular Dermatitis

3. NUMMULAR DERMATITIS Patient, 9 y.o.
Primary lesions discrete, coin-shaped, erythematous, edematous, vesicular and crusted patches
20-40 mm in diameter
papules and plaques
Begins on lower legs, dorsa of the hands, or extensor surfaces of the arms
Mainly over the antecubital and popliteal fossae
Infancy, lesions on the cheeks and scalp
As new lesions appear, old lesions expand by tiny papulovesucular (satellite lesions) appearing at the periphery and fusing with the main plaque.
Severe cases: palm-sized or larger patches
May form after trauma (Koebner’s phenomenon)
Pruritus is usually severe and of the same paroxysmal, compulsive quality, and nocturnal timing seen in circumscribed neurodermatitis
Itchy
temporarily relieved by application of hydrocortisone cream
Recurrent, 7 years duration

4. Stasis Eczema
Eczematous eruption of the lower legs secondary to peripheral venous disease
Venous incompetence  increased hydrostatic pressure and capillary damage with extravasation of red blood cells and serum
Incidence: a disease of adults, predominantly of middle and old age
May cause inflammatory eczematous process
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.

5. Stasis Eczema
Eczematous eruption of the lower legs secondary to peripheral venous disease
History:
Subacute or chronic, pruritic eruption of lower legs preceded by edema and swelling
Have often had thrombophlebitis
May cause inflammatory eczematous process
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.

6. Stasis Eczema: Physical Examination
Prominent varicose veins and pitting edema
Peripheral pulses in tact
Involved skin has brownish hyperpigmentation, dull erythema, petechiae, thickened skin, scaling, or weeping,
Any portion of the lower leg; predominant site is above the middle malleolus
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.

7. Stasis Eczema: Treatment
Therapy: the cornerstone of stasis dermatitis management is the prevention of venous stasis and edema. Supportive hose (Jobst) while the patient is ambulatory. Standing should be restricted, and patients who are obese should be placed on a weight reduction program. If this approach fails, bed rest with elevation of the legs is required. The dermatitic skin is treated witth topical steroids and wet compresses if oozing or crusting is present
Course and Complications:
Chronic and slowly progressive disease unless treated
Dusky erythema in areas of stasis dermatitis is the harbinger of leg ulceration
Allergy to topical preparations may occur in 60% of patients with stasis dermatitis. The compromised epidermal barrier from stasis allows sensitization to occur more easily than in normal skin. Contact dermatitis can easily be misdiagnosed as a flare-up of stasis dermatitis. Topical antibiotics are particularly prone to cause allergic contact dermatitis.
Reference: Lookingbill’s and Marks’ Principles of Dermatology, 4th ed.

8. KEY POINTS Eczematous patches or plaques overlying lower leg edema
STASIS ECZEMA
Patient
Disease of adults, predominantly middle and old age
Infancy to childhood (9 years old)
Subacute and chronic dermatitis, brownish hyperpigmentation, edema, petechiae
Papules and plaques
Lower leg, predominanty above the medial malleolus
Mainly over the antecubital and popliteal fossae
Infancy, lesions on the cheeks and scalp
Pruritic
Treatment: reduction of leg edema, compression stockings, leg elevation, with steroids for crusting and oozing
Itchy
Temporarily relieved by application of hydrocortisone cream
Recurrent, 7 years duration
KEY POINTS
Eczematous patches or plaques overlying lower leg edema
Chronic and itchy
Treat venous hypertension with compression stockings