Managing Nummular Eczema and Allergic Contact Dermatitis: A Case Study from Village Dermatology
At Village Dermatology in Katy and Houston, Texas, our dermatology team treats a wide range of skin conditions, from chronic inflammatory rashes to pigment changes and allergic reactions. This case features a 59-year-old female returning for follow-up care after treatment for nummular eczema, with additional concerns of post-inflammatory hyperpigmentation, scar care, and a new rash consistent with allergic contact dermatitis.
Patient Overview
The patient was first seen on June 3, 2025, for nummular eczema involving multiple areas, including:
Right knee
Left anterior distal thigh
Left and right popliteal areas
Right and left radial dorsal hands
She was treated with triamcinolone acetonide 0.1% cream, applied twice daily to affected areas as needed for flare-ups. Today, she returned for follow-up and reported significant improvement in itchiness, with no active rash present.
1. Nummular Eczema – Improved with Topical Steroids
Exam Findings:
No active eczema lesions; only residual post-inflammatory hyperpigmentation (PIH) visible.
Plan:
Discontinue triamcinolone cream for now
Restart during future flare-ups only
Skin care recommendations included:
Bathing with lukewarm water and gentle cleansers
Applying emollients 2–3 times daily
Avoiding scented detergents and fabric softeners
Keeping fingernails short to reduce scratching damage
Patient Education:
Eczema is chronic and may worsen with triggers such as dry weather, stress, certain soaps, and scratching. Ongoing moisturization is key to prevention.
2. Post-Inflammatory Hyperpigmentation (PIH)
Exam Findings:
Mild hyperpigmented patches on the right proximal pretibial region.
Plan:
Minimize sun exposure
Wear SPF 30+ broad-spectrum sunscreen daily
Educated the patient that PIH often fades over months to years
3. Scar Care – Epigastric Area
Exam Findings:
Well-healed scar secondary to a recent shave biopsy.
Plan:
Reassurance that scar color and texture may improve over time
Monitor for changes such as raised texture or itchiness (possible keloid formation)
Consider intralesional Kenalog (ILK) in the future if the scar becomes symptomatic
4. Allergic Contact Dermatitis (ACD) – New Rash on Buttocks
History:
Patient reported a mild rash on the gluteal cleft starting a few weeks ago, partially improved with one application of triamcinolone.
Exam Findings:
Well-demarcated, geometric eczematous patches in the buttocks area.
Plan:
Hydrocortisone 2.5% ointment applied twice daily for 2 weeks (max 2 weeks/month)
Switch to fragrance-free, hypoallergenic personal care products
Avoid potential triggers such as scented wipes, soaps, detergents, or lotions
Educated the patient on possible side effects of prolonged topical steroid use, including skin thinning and lightening
Key Takeaways for Skin Health
This case highlights how chronic skin conditions can be managed successfully with consistent care, trigger avoidance, and proper medication use. It also emphasizes the importance of differentiating between eczema flare-ups and new skin reactions like allergic contact dermatitis.
Do You Have Persistent Rashes or Skin Discoloration?
At Village Dermatology, we specialize in diagnosing and managing skin conditions like eczema, contact dermatitis, and pigment changes. We tailor every treatment plan to your needs, ensuring long-term control and skin health.
📍 Now accepting patients in Katy and Houston, Texas
📞 Call us today to schedule your skin evaluation
