Derm Cases · Dermatology / Paediatrics
OSCE — itchy infant cheeks: diagnose infantile AD, counsel barrier care, and safety-net eczema herpeticum
An 8-minute OSCE on diagnosing infantile atopic dermatitis, differentiating cradle cap and nappy rash, explaining emollient-first care and topical steroid principles, and recognising eczema herpeticum.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on diagnosing infantile atopic dermatitis, differentiating cradle cap and nappy rash, explaining emollient-first care and topical steroid principles, and recognising eczema herpeticum.
Brief (to candidate)
Parents of a 7-month-old with itchy cheek and extensor eczema seek a clear plan. You have 8 minutes to diagnose infantile AD, distinguish key mimics, explain barrier/topical care, and teach eczema herpeticum red flags.
Candidate instructions
- Diagnose and justify with itch + infantile distribution.
- Differentiate seborrhoeic dermatitis and irritant nappy dermatitis.
- Explain emollient-first care and topical steroid potency-by-site.
- Mention FLG barrier concept briefly.
- Safety-net punched-out erosions + fever.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Diagnosis | Infantile AD: itch, face/extensors, chronic/relapsing[1][2] |
| Differential | Greasy little-itch ISD; fold-sparing irritant nappy rash |
| Topicals | Emollients always; least potent effective TCS; step-down[3] |
| Pathogenesis pearl | Barrier/FLG and type 2 inflammation framing[5] |
| Emergency | Eczema herpeticum → urgent antiviral pathway[4] |
| Diets | Avoid unsupervised multi-food elimination |
Model key actions
- Written flare plan and follow-up advice.[3]
- Treat infection when clinically present; do not use antibiotics for all AD.
- Refer severe/refractory disease to paediatric dermatology.
Common errors
- Calling all infant facial rash “cradle cap.”[2]
- Starting elimination diets without indication.
- Missing herpeticum teaching.
References5ShowHide
- [1]Langan SM, et al. Atopic dermatitis. Lancet, 2020.PMID 32738956
- [2]Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol, 2014.PMID 24290431
- [3]Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol, 2014.PMID 24813302
- [4]Traidl S, et al. Eczema herpeticum in atopic dermatitis. Allergy, 2021.PMID 33844308
- [5]Palmer CN, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet, 2006.PMID 16550169