Discoid eczema, also termed nummular dermatitis, is a common type of eczema/dermatitis presented by well-defined, scattered, coin-shaped, and coin-sized plaques of eczema. 

In the previous post, we discussed the causes, prevalence, clinical features, diagnosis, and brief treatment options for discoid eczema.

Since discoid eczema is associated with the loss of skin barrier function, it is highly recommended to follow these key steps: protecting the skin from injury, applying emollients on regular basis, and avoiding allergens.

Discoid eczema often begins with minor skin injuries. For this reason, skin protection is needed. For instance, if hands are affected, it is highly recommended to wear gloves and use tools to help the skin avoid irritation that can be caused by friction, solvents, detergents, other chemicals, or excessive water.

The application of emollients can be achieved by having bath oils, using moisturising creams, and washing hands with soap substitutes. They can be applied to affected sites as frequently as required to relieve dryness, itching, and scaling. Emollients should also be applied to the unaffected areas to reduce dryness. Many people find glycerin and cetomacrogol cream, white soft paraffin, and wool fat lotions as helpful and effective emollients. 

If contact allergy has been identified by patch testing, exposure to this allergen should be avoided.

Anti-inflammatory treatments consist of using topical steroids and/or taking antibiotics. 

Topical steroids are anti-inflammatory creams or ointments that have to be prescribed by a dermatologist. They must be applied to affected areas once or twice daily for 2-4 weeks. Topical steroids help to reduce symptoms and clear dermatitis.

Antibiotics, such as erythromycin and flucloxacillin, are prescribed if dermatitis is crusted, sticky, or blistered. In some cases, discoid eczema can completely clear out on oral antibiotics but can re-occur once the course of antibiotics is discontinued. 

In cases of severe discoid eczema, the following treatment options can be offered: oral antihistamines, ultraviolet (UV) treatment, steroid injections, oral steroids, and other oral treatments.

Antihistamine pills can help to reduce the itch in some cases of discoid eczema. However, they do not clear the rash.

Phototherapy treatment sessions can be prescribed for the course of 6-12 weeks for generalised or widespread discoid eczema. It helps to reduce the itch and improve the rash.

Intralesional steroids can be injected into a few stubborn areas of discoid eczema, but this occurs quite rarely. This treatment is not suitable for multiple lesions.

Systemic steroids are recommended for only severe and extensive cases of discoid eczema. They are usually prescribed for a few weeks before continuing topical steroids and emollients on residual dermatitis.

Persistent and troublesome cases of discoid eczema are treated with ciclosporin, methotrexate, or azathioprine. These medications have to be carefully monitored by a specialist dermatologist. They may be more suitable in comparison with long-term systemic steroids.

Discoid eczema can transition into a chronic condition that often relapses during cold winter months. Many cases tend to resolve with time. 

Centre for Medical and Surgical Dermatology offers unique and personalized treatment options for discoid eczema for each patient.