Atopic eczema — structured viva

Structured oral on atopic eczema: defending generous steroids against steroid phobia with Cochrane safety numbers, fingertip-unit dosing, calcineurin inhibitor placement, bleach-bath honesty, dupilumab escalation and the sleep-psychological burden argument.

Prompt

The examiner opens: 'A colleague tells parents to avoid steroids because they thin children's skin — dismantle that, then tell me what you would do for severe disease.' The viva branches through safety numbers, dosing mechanics, infection emergencies, biologics and burden.

Stem

You are the GP. A parent says: "I never use the steroid cream you gave — it thins her skin." Her daughter's eczema has been flaring nightly for three months. ^[8]

References8Show

[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]Blauvelt A et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS). The Lancet, 2017.PMID 28478972
[4]George SM et al. Interventions to reduce Staphylococcus aureus in the management of eczema. The Cochrane database of systematic reviews, 2019.PMID 31684694
[5]Stacey SK et al. Topical Corticosteroids: Choice and Application. American family physician, 2021.PMID 33719380
[6]Axon E et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. The British journal of dermatology, 2021.PMID 34233978
[7]Bakaa L et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Journal of the American Academy of Dermatology, 2022.PMID 35367346
[8]Lax SJ et al. Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis. JAMA dermatology, 2024.PMID 39219446

Atopic eczema — structured viva

Stem

You are the GP. A parent says: "I never use the steroid cream you gave — it thins her skin." Her daughter's eczema has been flaring nightly for three months. ^[8]

References8Show

[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]Blauvelt A et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS). The Lancet, 2017.PMID 28478972
[4]George SM et al. Interventions to reduce Staphylococcus aureus in the management of eczema. The Cochrane database of systematic reviews, 2019.PMID 31684694
[5]Stacey SK et al. Topical Corticosteroids: Choice and Application. American family physician, 2021.PMID 33719380
[6]Axon E et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. The British journal of dermatology, 2021.PMID 34233978
[7]Bakaa L et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Journal of the American Academy of Dermatology, 2022.PMID 35367346
[8]Lax SJ et al. Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis. JAMA dermatology, 2024.PMID 39219446