Also known as

discoid eczema.
A chronic disorder of
unknown etiology.
Papules and
papulovesicles
coalesce to form
nummular plaques
with oozing, crust
and scale.


Also known as lichen
simplex chronicus
A chronic, severely
pruritic disorder
characterized by
one or more
lichenified plaques.

NUMULAR
DERMATITIS
NEURO-
DERMATITIS

Predominantly is a
disease of adulthood.
Men > women.
The peak incidence in
both males and females
is 50 65 years of age.
There is a second peak
in women around 1525
years of age.
Rare in infancy and
childhood.


Affects adults,
predominantly from
ages 30 - 50.
Females > males.
Patients with coexistent
atopic dermatitis have
been found to have
earlier age of onset
(mean age: 19 years) as
compared to the non-
atopic group (mean
age: 48 years).

NUMULAR
DERMATITIS
NEURO-
DERMATITIS
NUMMULAR DERMATITIS

Pathogenesis of N.D. is still unknown.
Most of the patients do not have a
personal or family history of atopy even
it may be seen in atopic eczema.
The state of hydration of the skin in
elderly patients decreased.
The role of infection (Candida albicans
and Staphylococcus).
ETIOPATOGENESIS
NEURO-
DERMATITIS
Induced by
rubbing and
scratching
secondary to
itch A variable
association
between
neurodermatitis
and atopic
disorders has
been reported
Environmental
factors have been
implicated in
inducing itch, such
as heat, sweat, and
irritation
Neurodermatitis
patients found to
have higher
depression scores
Neuro-
transmitters that
affect mood,
(dopamine,
serotonin, or
opioid peptides)
modulate
perception of itch
via descending
spinal pathways
1
2
3
4
5

Pinpoint oozing
and crusting
eventuate, and
are distinctive


Plaques range from 1- 3
cm in size. The surrounding
skin is generally normal but
may be xerotic

Pruritus varies
from minimal to
severe
Central
resolution may
occur, leading
to annular forms.
Chronic plaques
are dry, scaly,
and lichenified
The classic distribution of lesions is the
extensor extremities. In women, the
upper extremities, including the dorsal
hands are more common
Well-demarcated
coin-shaped
plaques form
from coalescing
papules and
papulovesicles
NUMULAR
DERMATITIS
1
2 3
4
5
6
Nummular dermatitis of hand
Discoid nummular dermatitis
(dry form)
Numular dermatitis of
body and extremities

Hyper- and
hypo-
pigmentation
are seen with
chronicity


Repeated rubbing and
scratching (conscious or
unconscious) gives rise to
a lichenified, scaly
plaque with excoriations


Itching may
be
paroxysmal,
continuous, or
sporadic

Most common
sites :
The scalp
Nape of the
neck (esp. in
women)
Ankles
Extensor aspects
of the extremities
Anogenital
region (women
labia majora,
men scrotum)
Itch severity worsen with
sweating, heat, or irritation
from clothing and
psychological distress

NEURO-
DERMATITIS
1 2
3 4
5
Follicular papules of
lichenification adjacent to
elbow.
Neurodermatitis of scrotum,
hyper- and hypo- pigmentation
with excoriation.
Nummular dermatitis
Pathology may show acute, subacute or
chronic dermatitis.
Acute phase:
The dominant
histopathology is
spongiosis which is
intercellular edema
that caused stretching
and ruptured of bonds
between cells which
accompanied by
formation of vesicle.
Subacute phase:
Spongiosis and
vesiculation
diminished and there
is an increased
acanthosis which is
related to keratinized
parakeratotic layer,
which usually consists
of coagulated
plasma layered with
picnotic nucleases
from inflamed cells.




Chronic phase:
Hiperkeratotic slowly
replaced the
parakeratotic layer.
Acanthosis is more
prominent than
spongiosis.

Neurodermatitis
The histological changes vary with site and duration.
Acanthosis and
variable degrees of
hyperkeratosis are
observed. The rete
ridges are lengthened.
Spongiosis is sometimes
present, & small areas
of parakeratosis are
occasionally seen.
Nummular dermatitis
Allergic contact dermatitis
Atopic dermatitis
Tinea corporis

Nerurodermatitis
Lichen planus
Psoriasis
ALLERGIC CONTACT
DERMATITIS
ATOPIC DERMATITIS TINEA CORPORIS
DEFINITION Type IV
hypersensitivity
reaction disease
Chronic relapsing skin
disease, mostly occur in
early childhood
Dermatophytosis
of glabrous skin
ETIOLOGY Skin contact with
environmental
allergens
Defect of skin barrier &
highly immune response
to allergen
T. tonsuran, T.
rubrum, E.
floccosum
CLINICAL
MANIFEST-
ATION
Acute pruritus,
erythema, edema,
vesicles
Chronic lichenified
erythematous plaque
Acute intense pruritus,
erythematous papule,
vesicle, serous exudate
Chronic lichenified &
fibrotic papule
Annular/serpigin-
ous plaque with
scale, vesicles at
border, central
clearing

PHOTO
DISTRIBUT-
ION
Hands, feets, face Flexural folds of
extremities
Glabrous skin
except palm,
soles, groin
LICHEN PLANUS PSORIASIS
DEFINITION Chronic inflammatory disorder
affecting skin, mucous
membrane, nails & hair
Chronic inflammatory skin
disorder
ETIOLOGY Defect in specific immunology
mechanism
Genetic defect with triggering
factor such as trauma,
infection, & medication
CLINICAL
MANIFEST-
ATION
Symmetric, erythematous to
violaceous(violet), flat
-topped, polygonal papules
Erythematous with silvery scaly
plaques, crust, pinpoint
bleeding
PHOTO
DISTRIBUTION Widespread, flexure aspects
of arms and legs
Scalp, elbow, knees, hands,
feet, nails
Nummular dermatitis
TOPICAL:
Topical steroids in the mid- to high-potency
range (cream/ointment). Used 2-3 times/day.
- 0,05% clobetasol proprionate
- 0,1% triamcinolone acetonide
Calcineurin inhibitors (cream/ointment). Used
2 times/day.
- Tacrolimus 0,03% children, 0.1% adult
- Pimecrolimus 1%
Tar preparations 2-5%
Emollients xerosis.
SYSTEMIC
Oral corticosteroid is given in severe cases.
Oral antihistamines if pruritus is severe.
- Hydroxizine 75 -100 mg/day
- Citirizine 5mg or 10mg per day
Oral antibiotics are indicated when
secondary infection is present.
- Dicloxacillin 500 mg every 6 hours

For widespread involvement, phototherapy
with broad-or narrow-band ultraviolet B may
be beneficial

NEURODERMATITIS

Treatment is aimed at interrupting the itch
scratch cycle.
Systemic causes of itch should be identified
and addressed.
TOPICAL
Potent topical steroids as well as nonsteroidal
antipruritic preparations such as pramoxine,
menthol, or phenol.
Emollients are an important adjunct.
Topical tacrolimus also can be applied.


SYSTEMIC

Intralesional steroids, such as triamcinolone
acetonide, given in varying concentrations
according to the thickness of the plaque.

Sedating antihistamines, such as hydroxyzine,
or tricyclic antidepressants, such as doxepin,
may be used to abolish night time itch.

Selective serotonin reuptake inhibitors (SSRIs)
have been recommended for relief of day
time pruritus.


Nummular dermatitis usually chronic.
Recurrence at prior sites of involvement is
a feature of the disease.

Neurodermatitis run a chronic course
with persistence or recurrence of lesions.
Exacerbations occur in response to
emotional stress.