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Diagnosing Eczema

by Sue Hubbard, M.D.

I saw a child in the office today whose mother was concerned that she had “ringworm gone wild”. She told me that her daughter had numerous places “including several obvious ones on her face and eyelid”. They seemed to be spreading, and she was using antifungal medication from another doctor. Despite this they were “overtaking her body”.

The first thing I thought is this is probably NOT ringworm with so many areas involved. It is fairly uncommon to see that many areas of involvement with the “dreaded ringworm” which is a fungal infection on the skin. She also made me laugh when she said she had considered leprosy in her diagnosis, but didn’t think the Google description matched. Gotta love the Internet.

After examining her cute daughter, who scratched her skin throughout our discussion, it was pretty clear that she had “nummular eczema”. These coin shaped dry, scaly, inflamed and itchy lesions are just another form of eczematous dry skin and are often confused with ringworm. They are usually in scattered areas chest, legs, arms, and in this case had become secondarily infected due to the persistent scratching, so they looked even nastier than usual eczema. Much relief by all that we could clear these up with several medications and not ship her off to the leper or ringworm colony.

So before jumping to ringworm gone wild, consider eczema and particularly nummular (coin shaped) eczema.

That’s your daily dose, we’ll chat again tomorrow!

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