European consensus recommendations for nummular eczema: A modified Delphi study

Nummular eczema (NE) is a chronic inflammatory skin disease characterized by intense pruritus, which can lead to sleep disturbance, reduced quality of life, and psychological distress. Despite its substantial burden on patients, there are currently no established clinical guidelines to support its diagnosis and management.

This study aimed to develop the first expert consensus-based recommendations for the definition, diagnosis, patient assessment and treatment of NE.

A Scientific Committee (SC) developed 64 statements across four domains-definition, diagnosis, patient assessment and treatment-based on a literature review and their own clinical expertise. A total of 63 experts (60 dermatologists and three specialist nurses) from 16 countries evaluated the statements via a two-round modified Delphi. Consensus was defined statistically, and statements reaching agreement informed the development of practical, evidence-informed clinical recommendations.

Of 64 statements, 49 (76.6%) achieved consensus: 5 of 7 on the definition, 11 of 18 on diagnosis, 15 of 18 on patient assessment and 18 of 21 on treatment. Recommendations emphasize clinical diagnosis and long-term, individualized management; endorsed treatments include high-potency topical corticosteroids, calcineurin inhibitors, topical JAK inhibitors, phototherapy and-off-label in most settings-selected systemic agents for refractory disease. The recommendations also highlight critical gaps, notably the need to develop and validate NE tailored patient assessment tools and to conduct large, well-designed clinical trials to establish the efficacy and safety of systemic therapies for NE, as well as defining specific treatment response targets.

These are the first expert consensus recommendations to provide a comprehensive framework for the diagnosis and management of NE in clinical practice. They offer practical, evidence-informed guidance to improve care for this underappreciated condition. Priority gaps include validated NE-specific assessment tools and randomized trials of systemic therapies.