Abstract

NOGUEIRA, Catarina Pinto; SOUTO, Inês Valga; BRANDAO, Margarida  and  ROCHA, Rui. Nummular eczema: a challenging diagnostic. Rev Port Med Geral Fam [online]. 2019, vol.35, n.4, pp.330-334. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i4.12139.

Introduction: The family doctor frequently handles patients with dermatological diseases, whose diagnostic is a challenge. Nummular eczema is widespread eczema that is characterized by pruritic and well delimited discoid lesions. It affects more commonly males over 50 years of age and the diagnostic is clinical. This case aims to remind family doctors its clinical presentation, differential diagnosis, treatment, and prognosis. Case report: Man, 53 years old, locksmith, married, with previous history of smoking, alcoholism, dyslipidemia and transmission hypoacusia, who refers the onset of macules and erythematous-desquamative plaques, rounded, of variable diameter (1-3cm), very pruritic, scattered in the upper and lower limb, with three month's evolution. He reported nocturnal worsening of pruritus. Not achieving general health or other systemic symptoms. There was no infectious process at the onset of the cutaneous manifestations. Prior to the diagnosis, the patient was observed in three consultations performed by different physicians: initially, the lesions were interpreted as an allergic reaction, as he handled irritating products at work, later as Tinea corporis and finally, it was hypothesized that it was a Psoriase Gutata and was treated accordingly without success. Given the diagnostic difficulty, a second opinion was requested to dermatology, who considered it to be nummular eczema. Comment: Nummular eczema is an entity with unknown etiopathogenesis, whose clinical manifestations are particular, preferably reaching the extremities. It is important to consider other differential diagnoses, such as atopic dermatitis, allergic dermatitis, corpora, and Psoriase gutata. The treatment included the application of moisturizers and topical corticosteroids. Its prognosis is excellent, despite the possibility of recurrence. The disclosure of this clinical case will allow us to reflect on this pathology, reinforcing the importance of differential diagnosis and appropriate treatment.

Keywords : Nummular eczema; Diagnosis; Treatment.

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