Discoid eczema is an uncomfortable chronic skin condition; like other types of eczema and dermatitis, it involves itchy, dry and inflamed skin, and flares can last weeks, months or even years. Here we look at the best way to manage this persistent type of eczema.
What is discoid eczema?
Discoid eczema, also known as discoid dermatitis or nummular eczema, is characterised by circular or oval patches of inflamed skin, hence the name (‘nummular’ means coin shaped). It tends to develop from small areas of bumps, itchy or blistered skin, which grow outward into circular patches. These patches can continue to expand until they’re between 1 and 3cm in diameter. Often, the inflammation remains on the outer edge, with the central part of the disc clearing up, leaving ‘normal’ skin in the middle.
Who gets discoid eczema?
The condition mostly affects adults, slightly more older men than women, and particularly those who are already prone to atopic dermatitis, other kinds of eczema, and related conditions such as hayfever and asthma. There also seems to be a link to chronic alcoholism in older men.
What causes discoid eczema?
The condition is a little bit mysterious, in that a root cause is hard to find. It doesn’t seem to be inherited, it’s not contagious, and it isn’t the same condition as contact dermatitis (although they are associated!). Triggers for a flare-up of discoid eczema include having very dry skin; suffering an injury to your skin (an insect bite, a burn, a scratch); being in contact with an irritant substance; various medications, such as interferon and ribavirin (when used together), tumour necrosis factor-alpha (TNF-alpha) blockers, and statins.
Can you get rid of discoid eczema?
Unfortunately for sufferers, discoid eczema isn’t something that you can easily get rid of once and for all. Like many other types of eczema, it’s a chronic condition, which means it’s a long-term, persistent problem without a cure. The chances are that if you’ve had one attack of discoid eczema, you will get more, and it’s fairly likely to recur on the same areas of your body. Some people find that a patch of discoid eczema stubbornly refuses to clear, and can last for years.
However, your discoid eczema can go into remission for long periods of time, which means that you can be clear from flares for weeks, months or years.
What’s the best way to manage discoid eczema?
Managing discoid eczema involves a combination of things, both as long-term preventative strategies and in the short-term to manage painful or distressing symptoms.
- Emollients: the use of non-irritant emollients during and between flares is key to managing your skin. Use an effective, scent-free moisturising ointment, oil or cream according to preference and convenience very day, even when your skin is not flaring. Discoid eczema has an association with an impaired skin barrier, so emollients will help protect dry or fragile skin from dehydration and damage. Emollient ointments which have a high oil content are more effective at locking moisture into the skin and calming the itch than lotions or creams. Using your emollients under wet wraps can be effective.
- Avoiding irritants: if you’re prone to discoid eczema, it’s sensible to identify the irritants your skin might be reacting to, and then protect your skin from them. Possible culprits include scented toiletries, soaps, foaming washes or bubble baths, cosmetics, metals, harsh household detergents, industrial chemicals, solvents, prolonged contact with water, depending on where on your body your eczema occurs. You may need to wear gloves, protective clothing, or switch your toiletries and skincare to hypoallergenic brands.
- Steroids: in severe cases of discoid eczema, your GP may prescribe topical, oral, or even injected steroids, to calm down a bad flare. Steroids are not a long-term strategy, as they can have serious side-effects, but they may be suitable to break a cycle of itchiness, inflammation and discomfort, and prevent the eczema from getting infected.
- Antihistamines: anti-itch medications can help make the symptoms of discoid eczema more comfortable.
- Non-steroidal medications: a group of drugs that regulate the immune system response, including methotrexate, azathioprine or cyclosporine, can be preferable to steroids for long-term use.
- UV phototherapy: a course of phototherapy can be prescribed if your discoid eczema is particularly severe or persistent.
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