Hello fabiete,
I believe that the condition to which you refer is nummular eczema,
also known as discoid eczema:
“Nummular eczema usually appears on the arms and legs. Red, scaly,
coin-shaped patches characterize nummular eczema. The disorder's name
comes from nummus, the Latin name for 'coin.'
As the condition clears, the patches heal from the inside skin layers
to the outer layer, the healing lesions resemble red rings, thus
accounting for the disorder's other name, discoid eczema. Discoid
eczema is associated with the winter season, conditions of low
humidity, and dry skin.”
From The More Common Types of Eczema and Their Symptoms
http://www.treatments-for-eczema.com/html/types_of_eczema.php3 , on an
NCERx Healthcare web site (“NCERx is a profitable, private interactive
healthcare publisher, dedicated to delivering timely healthcare
information to consumers and matching clinical trial candidates with
investigator sites and sponsors. Although a commercial company, NCERx
has a mission to support healthcare knowledge advancement through
research grants and free web services for research foundations.”
http://www.ncerx.com/html/about-us.php3 )
With respect to nummular eczema, specifically, I have found the
following information by doing a search on nummular eczema on the
Medline database of medical journal articles
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi )
Halcinonide cream (Halog) is a medium-high potency corticosteroid
cream, which was found to be effective in a study of 101 patients with
moderate-severe skin conditions, including nummular eczema.
“Halcinonide cream was prescribed twice or three times a day for three
weeks, and patients were followed-up weekly during this period.
Sixteen patients stopped treatment after two weeks because their
lesions had cleared. By the end of three weeks, the condition in 46 of
the patients had completely resolved, the condition in 39 showed
marked improvement, the condition in 10 had improved moderately, the
condition in 5 showed mild improvement, and the condition in 1 did not
show any improvement. No local or systemic side effects were
reported.”
“Efficacy of halcinonide cream, 0.1 percent, in the treatment of
moderate and severe dermatoses” by Belknap BS, Dobson RL, published in
Cutis, 1981, Volume 27, pages 433-435
Abstract at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7226895&dopt=Abstract
More information about this and similar medications from MedlinePlus:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202016.html
I also found a number of papers about the beneficial effects of
halometasone cream and ointment. This is a another medium-high potency
corticosteroid preparation similar to halcinonide, but it is not
available in the USA.
Doxepin cream, applied 4 times daily, was found useful in a group of
309 patients, including 87 with nummular eczema, with 60% experiencing
relief from itching within 24 hr and 84% by the end of the 7-day
study.
The antipruritic effect of 5% doxepin cream in patients with
eczematous dermatitis. Doxepin Study Group. By Drake LA, Millikan LE.
Published in Archives of Dermatology, 1995, Volume 131, pages
1403-1408
Abstract at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7492129&dopt=Abstract
More information on this medication from MedlinePlus:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202751.html
Some patients with various types of eczema, including nummular eczema,
were found to experience a worsening of symptoms when they were
challenged orally with salts of chromium, cobalt or nickel. Some of
these patients experienced improvement after following a diet low in
metal for at least four weeks.
“Oral challenge with metal salts. (II). Various types of eczema” by
Veien NK, Hattel T, Justesen O, Norholm A, published in Contact
Dermatitis, 1983, Volume 9, pages 407-410
Abstract at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6627927&dopt=Abstract
The Internet Health Library has a report on the improvement caused in
some eczema patients by a low nickel diet
http://www.internethealthlibrary.com/Health-problems/Eczema%20-%20research-nickel-000228.htm
It concludes: “These research papers indicate that eczema sufferers
may be helped by avoiding the main food groups which tend to be high
in nickel - chocolate, nuts, beans, porridge oats - and that an
allergy test or food elimination diet are worth considering to help
overcome the condition.”
The problem with a low chromium diet is that it can cause other
problems, because chromium is important in the functioning of insulin
in the body. The sources of chromium in the diet are: “brewer's
yeast, lean meats (especially processed meats), cheeses, pork kidney,
whole-grain breads and cereals, molasses, spices, and some bran
cereals. Brewer's yeast grown in chromium-rich soil is the best
dietary source for chromium. Vegetables, fruits, and most refined and
processed foods (except for some processed meats, which contain high
amounts of chromium) contain low amounts of chromium. Hard tap water
can supply 1 to 70% of your daily requirement. Cooking in stainless
steel cookware increases the chromium content of food.”
http://www.usadrug.com/IMCAccess/ConsSupplements/Chromiumcs.shtml (web
site of USA Drug stores)
A paper on chronic hand eczema by Herbet P Goodheart published in
Women’s Health in Primary Care, 2001, Volume 4, pages 515-518, is
available at: http://www.womenshealthpc.com/8_01/pdf/515DermRounds.pdf
and describes low cobalt and low nickel diets, but these do not get
approval from the author: “For nickel-sensitive patients, diets
that avoid foods rich in nickel, such as canned foods, foods that are
cooked with nickel-plated utensils, herring, oysters, asparagus,
beans, mushrooms, onions, corn, and spinach. Such restrictions are
difficult for patients to follow and only rarely successful. For
cobalt-sensitive patients, a low-cobalt diet, which avoids apricots,
beans, beer, beets, cabbage, chocolate, cloves, cocoa, coffee, liver,
nuts, scallops, tea, and whole grain flour. This measure is also
therapeutically unrealistic.”
If you do want to consider the diet route, it would be useful to
establish first whether you do suffer a flare-up to any of these
metals.
The NCERx site mentioned above also gives some general advice on
prevention and treatment of eczema, which is applicable to all types.
Prevention http://www.treatments-for-eczema.com/html/prevention.php3 :
Take quick lukewarm showers rather than long hot baths. If you want to
have a bath, use lukewarm water and do not stay inside for more than
10-20 minutes. “Avoid using soaps: even a mild soap can dry and
irritate skin. When you dry after a shower, pat yourself dry: rubbing
can do as much damage to your skin as scratching. Once dry, moisturize
with a gentle cream, ointment, or lotion.”
Things that cause allergies can trigger eczema and itching, so the
recommendation is to avoid known allergens, including dust mites, pet
dander, perfumes and soaps. “The best strategies to minimize contact
with dust mites are washing clothing and bed linens and vacuuming on a
regular basis. Pillow and mattress wraps also help reduce contact with
mites. Some people replace carpet with linoleum, wood or other
flooring, as carpets tend to harbor large numbers of dust mites.”
Excessive sweating can make eczema worse, so losing weight can help,
but do avoid exercise programs that cause profuse sweating and wear
soft absorbent clothes during exercise.
Do avoid scratching the itchy bits!
“Laundry soap can leave residue on clothes that aggravates eczema.
Look for laundry soap designed for sensitive skin. Some people prefer
to use baking soda to wash their clothes. Whether using a gentle
laundry soap or baking soda, rinse clothes thoroughly to remove any
residues.
If low humidity causes your skin to dry and crack, try using
humidifiers in your home or office. Humidifying the air in the rooms
where you spend time is a good strategy if you are prone to dry skin
conditions.”
Treatment http://www.treatments-for-eczema.com/html/eczema_treatments.php3
:
The site points out that at the moment there is no definitive cure and
goes into the pros and cons of the treatments currently available.
Topical treatments, ie treatments applied directly to the skin start
with moisturizers, which “are the most common topical treatments.
Ointments, creams and lotions can "lock" moisture in, preventing the
skin from drying out and cracking.” If these do not have sufficient
effect on symptoms, other topical treatments include:
Coal tar – a traditional remedy, which can aggravate symptoms and
cause the skin the become sensitive to sunlight. It is also sticky
and messy to use.
Hydrocortisone Cream – hydrocortisone,, a corticosteroid, can be
useful, but may become less effective after prolonged use. In fact,
long-term use is not recommended, because it can “cause thin skin,
stretch marks and excess body hair.”
Topical Immunomodulators: these are a new class of non-steroidal
anti-inflammatory drugs, which have fewer side effects than
corticosteroids, and which have been found fully or partially
effective in about 80% of eczema cases. Tacrolimus is one such
medication.
MedlinePlus has information about tacrolimus at
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500279.html
Oral medication is used in severe cases, or to treat complications.
The substances used include:
Antibiotics: used to treat bacterial infections that can arise with
eczema and worsen symptoms. However, they can have side effects.
Antihistamines: control itching, but might not be particularly
effective, because histamine does not play a big part in eczema. The
older types can cause drowsiness, and so should not be used while
driving.
Corticosteroids: although these can be useful in severe cases, there
is more chance of side effects than with hydrocortisone cream.
Therapy with ultraviolet light can reduce symptoms. The effect can be
increased by using light therapy in combination with a drug called
psoralen.
Finally, the web page recommends keeping a food diary to see if any
foods are associated with a worsening or improvement of symptoms. This
really belongs to the prevention measures listed above.
One further approach, which is still controversial, is the use of
Chinese herbal medicine. Some studies have found this effective in the
treatment of eczema and psoriasis, while others have found no benefit.
In addition, cases of toxic reactions to the medications used have
been reported. I have not found any literature on the use of Chinese
herbal medicines in the treatment of nummular eczema specifically.
One review on the use of Chinese remedies in eczema in general,
published in 1999, found only two published studies that had been
properly conducted. The review authors concluded: “Both [studies]
imply that a complex mixture of Chinese herbs is more effective than
placebo in treating eczema. Yet several caveats exist, most
importantly the lack of independent replication. Adverse effects have
also been reported…. At present it is unclear whether Chinese herbal
treatments of eczema do more good than harm.”
“The treatment of eczema with Chinese herbs: a systematic review of
randomized clinical trials.” By Armstrong NC, Ernst E., published in
British Journal of Clinical Pharmacology, 1999, Volume 48, pages
262-264
Abstract at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?holding=f1000&cmd=Retrieve&db=PubMed&list_uids=10417508&dopt=Abstract
Search strategies on Google, Medline and MedlinePlus: 1. eczema types,
2. “nummular eczema” 3. searches on individual drug names, 4. “low
metal diet”, “low nickel diet”, “low cobalt diet”, “low cadmium diet”,
5 eczema treatment Chinese |
