DEAR DR. GOTT:
I am an 86-year-old male and approximately two years ago was diagnosed with nummular dermatitis. This disease causes spots of rashes which appear on all parts of my body after the areas get very itchy. I trust my diagnosis because my dermatologist is a professor of dermatology at the Yale University School of Medicine. He said there is no cure and very little research because very few people have this disease. I am currently taking triamcinolone acetonide which I have to apply to all affected spots twice a day.
Do you know anything about this condition? Can you offer any suggestions?
DEAR READER:
Nummular dermatitis (ND) is a form of eczema. It usually occurs on the arms and legs but can appear anywhere on the body. The rash generally starts as papules (raised areas of skin) that then turn into plaques (flattened patches, such as those associated with psoriasis). These areas are generally very itchy and are frequently accompanied by abnormal dryness. The areas are prone to infection, cracking, bleeding and so forth caused by scratching.
There are two peak ages of occurrence. Those between 60 and 70 are most commonly affected with a predominance in men. The second group is individuals between the ages of 20 and 30. Those in this group tend to be female and many also have atopic dermatitis (common eczema). This disorder is rare in children.
Symptoms often come and go with winter. Cold or dry conditions may worsen the condition while sun, humidity and the use of strong moisturizers appear to reduce symptoms. Areas of old patches are often where new outbreaks occur. There is no known cause but most authorities believe it may be multi-factoral.
Treatment for generalized (over most of the body) ND can include bed rest, oral antibiotics or steroids and being in a cool (not cold) environment. Taking cool or lukewarm baths or showers at least once or twice daily immediately followed by a moisturizer, such as Vaseline, can be beneficial. The skin must be damp while the moisturizer is applied to seal it in. Depending on the severity of the outbreak, whether it is generalized or localized, some sufferers may require oral steroids, antihistamines, sedatives, or antibiotics.
Your current treatment of triamcinolone acetonide is a topical anti-inflammatory glucocorticoid which is essentially a steroid cream. As for suggestions, I am not a dermatologist. In my opinion you are on an appropriate treatment. Just as there is no cure for common eczema, there is no cure for this form. If you have further questions about prevention, treatment and self-care techniques, I urge you to speak to your physician who, undoubtedly, has access to the newest treatments available.
To give you related information, I am sending you a copy of my Health Report “Dermatitis, Eczema and Psoriasis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
About Dr. Gott