GP CCE Cases · dermatological-presentations
Infant with weeping eczema and steroid-phobic parent — CCE clinical encounter
CCE-style clinical encounter: an 8-month-old with weeping facial eczema whose mother fears steroids and under-doses. The candidate must treat the flare correctly, defuse steroid phobia with safety numbers, prescribe emollients by quantity, teach fingertip units, and safety-net for infection.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
An 8-month-old presents with weeping facial and extensor eczema breaking sleep nightly. The mother applies a fingertip of 1% hydrocortisone across the whole body once weekly 'because steroids thin skin', bathes in bubble bath, and asks about food allergy testing. Growth is normal; no fever; no punched-out lesions.
Objectives
- Diagnose atopic eczema clinically and explain the age-based distribution to the parent. [4]
- Correct under-dosing: demonstrate fingertip units and prescribe adequate quantities of emollient plus mild-potency steroid for the face. [1]
- Defuse steroid phobia using the Cochrane safety numbers. [3][4]
- Replace bubble bath with soap substitute; discuss food-allergy testing limits without unguided elimination. [4]
- Safety-net: fever, punched-out erosions or vesicle clusters = same-day review (eczema herpeticum/impetiginisation). [4]
References4ShowHide
- [1]Long CC et al. The finger-tip unit--a new practical measure. Clinical and experimental dermatology, 1991.PMID 1806320
- [2]Simpson EL et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. The New England journal of medicine, 2016.PMID 27690741
- [3]Axon E et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. The British journal of dermatology, 2021.PMID 34233978
- [4]Lax SJ et al. Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis. JAMA dermatology, 2024.PMID 39219446