Paeds Vivas · allergy-and-immunology
Atopic dermatitis and the atopic march — viva
Branching clinical structured oral on the assessment, barrier-and-Th2 pathophysiology and stepwise management of an infant with atopic dermatitis and the atopic march.
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Target exams
RACP DCEMRCPCH Clinical
Prompt
A 9-month-old boy is brought to the general paediatric clinic with a five-month history of an intensely itchy rash on his cheeks, scalp and the extensor surfaces of his arms. He scratches until the skin weeps and wakes repeatedly at night. His mother has asthma and his father had childhood eczema. You are asked to assess and manage him.
Opening (2 minutes)
The candidate should recognise the classic picture of infantile atopic dermatitis in a child with a strong atopic family history, apply the UK Working Party diagnostic criteria, and commit to excluding alternative diagnoses. The intensely itchy rash on the cheeks, scalp and extensor surfaces, the nocturnal scratching and sleep disturbance, the sparing of the nappy area, and the bilateral parental atopy together make atopic dermatitis the leading diagnosis. [1]
References3ShowHide
- [1]Williams HC Clinical practice. Atopic dermatitis. N Engl J Med, 2005.PMID 15930422
- [3]Palmer CN, Irvine AD, Terron-Kwiatkowski A Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet, 2006.PMID 16550169
- [6]Sidbury R, Alikhan A, Bercovitch L Executive summary: American Academy of Dermatology guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol, 2023.PMID 36623556