Atopic eczema — KFP-style written assessment

KFP 1 (10 marks)

An 8-month-old has weeping facial and extensor-surface eczema failing soap-based bathing. The mother uses a fingertip of hydrocortisone 1% across the whole body once weekly because she read that steroids "thin the skin". Sleep is broken every night. ^[5][6]

1. Name the two management errors and the correct approach for each. (4) ^[5]
2. Address the mother's steroid fear with safety numbers. (3) ^[8][6]
3. Prescribe the emollient regimen with quantities. (3) ^[5]

Model answers

1. Error one: soap-based bathing — switch to soap substitute/emollient wash. Error two: under-dosing (one fingertip for the whole body is far below requirement; face needs ~2.5 FTUs alone per application) applied too infrequently. Correct approach: generous emollient twice daily plus mild-potency steroid (hydrocortisone 1–2.5%) to the face daily until clear, then step down; review within one-to-two weeks. ^[5]
2. Cochrane NMA found no increased skin thinning with short-term use of any potency; over long courses thinning occurred in only 0.3%. Adrenal suppression on biochemical testing was 3.8% in children across observational studies and reversed when treatment ceased. Untreated eczema itself causes scarring, sleep loss and suffering — under-treatment is the real harm. ^[8][6]
3. Emollient ointment or cream, roughly 250 g per week scaled for her size, applied at least twice daily and after every wash in downward strokes; use an emollient soap-substitute for bathing. Expect to re-prescribe monthly — running out early signals correct use. ^[5]