Biologics and Small-Molecule Inhibitors for the Treatment of Nummular Eczema: A Systematic Review

Background Nummular eczema (NE) is a chronic, pruritic dermatitis with substantial patient burden and no FDA-approved therapies. Emerging data suggest that biologics and small-molecule inhibitors may be promising therapeutic options for NE.Methods On October 29, 2025, PubMed, Embase, and the Cochrane Library were searched using PRISMA guidelines for English-language human clinical studies and cases evaluating biologics and small-molecule inhibitors for the treatment of NE.Results Of 219 studies identified, 10 met the inclusion criteria. Grade of recommendation: B supporting dupilumab and tralokinumab. Grade of recommendation: C supporting roflumilast and delgocitinib. Grade of recommendation: B against apremilast.Conclusions Current evidence supports dupilumab and tralokinumab for the treatment of NE. Roflumilast and delgocitinib should be reserved for selected cases, and apremilast is not recommended. Randomized controlled trials are needed to establish optimal treatment for patients with NE. &nbsp.