How to Tell the Difference Between Nummular Eczema and Ringworm
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Published On: Mar 6, 2023
Last Updated On: Mar 6, 2023
Origin stories reveal the formative events — the victorious wins and momentary setbacks — that explain how a character got to where they are today.
And like any complex character, eczema’s origin story follows a similar path: ground-breaking treatments built upon years of questions, trials and errors and revolutionary breakthroughs.
But what can eczema’s origin story tell us about where we’re headed today? Let’s step back in time to discover the major milestones in eczema’s history, understand how assumptions about eczema and its treatments evolved and, perhaps, catch a glimpse of the future.
Before eczema earned its formal title, descriptions of similar skin conditions appeared in ancient Egyptian texts.
“As far back as we can see, in one of the earliest known medical documents called the Ebers Papyrus thought to be written more than 3,000 years ago, there have been skin issues described,” said Dr. Peter Lio, Assistant Professor of Clinical Dermatology and Pediatrics at Northwestern University’s Feinberg School of Medicine.
While the document doesn’t specify eczema, Dr. Lio noted it wouldn’t be surprising if that were the case. Early remedies listed for “enduring itch” on the Ebers Papyrus included compresses of bean and onion mixtures as well as milk and sea salt.1
Hippocrates, traditionally thought responsible for the Hippocratic Oath and referred to as “the father of modern medicine,” also contributed theories on the origins and treatment of eczema-like skin conditions around 400 BC.2,3
We can thank two English doctors, Robert Willan and Thomas Bateman, for coining the term “eczema” in 1817 to describe a fluid-filled, blistering rash (like a sunburn).4 It’s the first time we see the term appear, though it doesn’t match the types of eczema we typically think of today.5
In the early 1900s, as dermatology continued to distinguish itself from general medicine, doctors altered their approach to the study of the skin.
“Dermatologists began to differentiate between different types of skin conditions, including eczema, and to categorize them based on their symptoms and appearance,” explained Dr. Lio. These new classifications helped doctors better understand and differentiate between similar-appearing conditions, like eczema and psoriasis, which allowed for more specialized studies.
A description of the most common type of eczema we know today appeared in 1933. Atopic came from the word “atopy,” which describes a predisposition to respond immunologically to diverse antigens/allergens, and “dermatitis”, which refers to inflamed skin.6 From then on, atopic dermatitis defined what we most often think of as the most common form of eczema today: allergen-related, itchy and inflamed skin.
In the 1950s, a revolutionary treatment for eczema arrived on the scene. “The development of corticosteroids, for the first time, offered significant and reliable relief for patients. Perhaps more importantly, it opened the door to learning about the condition and began the race to find non-steroidal treatments,” said Dr. Lio.
Two researchers synthesized Compound F, which you may know more commonly now as hydrocortisone, in 1952.1 Other corticosteroids, or topical anti-inflammatories, followed soon after.
Today, doctors prescribe varying concentrations of corticosteroids for eczema for their effectiveness in stopping the itch and inflammation. “Topical steroids are the mainstay of anti-inflammatory treatment,” said Dr. Lio. “I wish they weren’t. I’m a searcher and I want to find other things that are better and safer. But topical steroids are incredibly powerful, and when used correctly, they do a great job and are relatively safe.”
You can pick up a mild corticosteroid over the counter, but a dermatologist must prescribe stronger concentrations. The stronger the corticosteroid, the more someone’s risk increases for rare but painful side effects, like topical steroid withdrawal. Hence the continued push, as Dr. Lio noted, for more non-steroidal options.
Current eczema research focuses on the cause and effect between the bacteria, fungi and viruses on our bodies (our microbiome) and our intermittently itching skin. “We are now understanding that our environment and the microbiome are playing a crucial role in this condition,” said Dr. Lio. “Something that has long been underappreciated.”
Today we know more about our skin’s barrier and its connection to our immune system. A recent study described people with eczema as having less microbial diversity (different kinds of bacteria) on the skin and in the gut.7 Our microbiomes are “highly personal,” and this discovery could reveal a path to more precise and personalized eczema treatments.8
New research also alerts us to the connection between polluted air, stress, diet and other environmental factors to eczema.9 As the climate continues to change and urbanization rises, so does their impact on our immune systems and, as a result, our eczema.
We must remember that dermatology, in contrast with other fields of medicine, is still quite young. There’s much we know about eczema and much still to discover.
We’ve come a long way from the first iterations of milk and salt compresses, but our bodies are dynamic and ever-changing. Determined doctors and researchers devote countless hours to eczema research and develop new treatments and theories every year.
“I wish more people knew that this has been with us for a long time and that it is a difficult problem that has no easy solution,” noted Dr. Lio. “If it did, one of the great minds throughout history would have solved it already! It’s not the patient’s fault.”
Even on days when it seems like the itching won’t stop, it’s important to remember you’re not alone. Other people with eczema, doctors, researchers and caregivers — we’re all part of the still unfolding story of eczema.
References:
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
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