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Nummular Eczema and Contact Allergy: A Retrospective Study

Bonamonte, Domenico MD; Foti, Caterina MD; Vestita, Michelangelo MD; Ranieri, Luigi Davide; Angelini, Gianni MD

doi: 10.1097/DER.0b013e318260d5a0

Background Etiopathogenesis of nummular eczema is obscure; many causative factors have been proposed. Only a few studies investigated the relevance of contact allergy.

Objective This retrospective study aimed to investigate the role of contact allergy in the underlying mechanism of nummular eczema.

Methods From the 29,323 consecutive patients, we patch-tested for eczematous dermatitis of various type, 1022 (3.5%) with nummular eczema were enrolled. Data were collected for each patient, including age, sex, occupation, symptoms onset and duration, onset and spread sites, and clinical evidence or history of atopy. Histological analyses of acute phase lesions were carried out in some patients.

Results Peak incidence of age at disease onset was found in the third decade of life. Predominant sites of lesions were upper (75.8%) and lower (64.5%) limbs, followed by trunk, dorsum of the hands, and face and neck. Three hundred thirty-two (32.5%) of 1022 patients showed positive reactions to 1 or more allergens. Highest sensitization rates were found with nickel sulfate (10.2%), potassium dichromate (7.3%), and cobalt chloride (6.1%). Histopathology showed less pronounced spongiosis in atopic subjects and the elderly.

Conclusions Because this study demonstrates that contact allergy is common with nummular eczema, patch testing is strongly advisable in every patient with persistent nummular dermatitis.

From the Department of Internal Medicine and Clinical Oncology–Section of Dermatology, University of Bari Medical School, Bari, Italy.

Address reprint requests to Domenico Bonamonte, Clinica Dermatologica, Policlinico, Piazza Giulio Cesare, 11 70124 Bari Italy. E-mail:

The authors have no funding or conflicts of interest to declare.

©2012American Contact Dermatitis Society, All Right Reserved
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