Evaluation of the role of patch test in endogenous eczemas

Background: Endogenous eczemas have a significant effect on quality of life of patients and is a huge burden on healthcare. There is evidence that external factors play an important role in endogenous eczemas. The study was conducted to evaluate the role of patch test in endogenous eczemas and to identify any causal or aggravating allergen, the avoidance of which could augment response to standard therapy and prevent relapse.Methods: Four groups of 27 patients each, with clinical diagnosis of one of the major endogenous eczema namely, Atopic dermatitis, nummular eczema, pompholyx and seborrhoeic dermatitis satisfying the inclusion and exclusion criteria were included in the study. Demographic and clinical details were recorded and were patch tested with the Indian standard patch test battery. Dermatology life quality index (DLQI or children’s DLQI) was used at the presentation and after 03 months to assist in assessing the subjective improvement after avoidance of the agents incriminated by the patch test. Results: Of the 108 study participants, 61 (56.5%) patients had one or more positive results in the study, with maximum 21 (77.8%) in pompholyx and minimum of only 10 (37%) in patients of seborrhoeic dermatitis group. About, 36 (33.3%) patients had no change and 05 (4.6%) had worsening of their eczema.Conclusions: We found positive outcome in the form of clinical improvement or cure following the avoidance of allergens implicated by patch testing. This study recommends inclusion of patch test in the management protocol of endogenous eczemas.

Nummular Eczema: An Updated Review

Background: Nummular eczema may mimic diseases that present with annular configuration and the differential diagnosis is broad. Objective: This article aimed to provide an update on the evaluation, diagnosis, and treatment of nummular eczema. Methods: A PubMed search was performed in Clinical Queries using the key terms “nummular eczema”, “discoid eczema”, OR “nummular dermatitis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. Patents were searched using the key terms “nummular eczema”, “discoid eczema”, OR “nummular dermatitis” in www.google.com/patents and www.freepatentsonline.com. Results: Nummular eczema is characterized by sharply defined, oval or coin-shaped, erythematous, eczematous plaques. Typically, the size of the lesion varies from 1 to 10 cm in diameter. The lesions are usually multiple and symmetrically distributed. Sites of predilection include the lower limbs followed by the upper limbs. The lesions are usually intensely pruritic. The diagnosis is mainly clinical based on the characteristic round to oval erythematous plaques in a patient with diffusely dry skin. Nummular eczema should be distinguished from other annular lesions. Dermoscopy can reveal additional features that can be valuable for correct diagnosis. Biopsy or laboratory tests are generally not necessary. However, a potassium hydroxide wet-mount examination of skin scrapings should be performed if tinea corporis is suspected. Because contact allergy is common with nummular eczema, patch testing should be considered in patients with chronic, recalcitrant nummular eczema. Avoidance of precipitating factors, optimal skin care, and high or ultra-high potency topical corticosteroids are the mainstay of therapy. Recent patents related to the management of nummular eczema are also discussed. Conclusion: With proper treatment, nummular eczema can be cleared over a few weeks, although the course can be chronic and characterized by relapses and remissions. Moisturizing of the skin and avoidance of identifiable exacerbating factors such as hot water baths and harsh soaps may reduce the frequency of recurrence. Diseases that present with annular lesions may mimic nummular eczema and the differential diagnosis is broad. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made, and appropriate treatment initiated.

Nummular Contact Eczema: Presentation of a Pediatric Case

The etiopathogenesis of the nummular eczema is not fully known. Various causative factors have been proposed, and among these only a few studies investigate the relevance of contact allergy. Here, we present a case of nummular contact eczema in an 8-year-old allergic to perfumes. Since atopic dermatitis may also present with different clinical phenotypes, among which nummular eczema is quite frequent, the possible significant differences between non-atopic and atopic nummular diseases are considered. Based on the high incidence of contact sensitization in all cases of nummular eczema, it is recommended to perform patch tests for diagnostic-preventive purposes.