Module 2: Case Studies

Question 1

What is the morphology of the rash in this 3-year-old child?

Answer 1

Erythematous (red), scaly, dry, and excoriated patches, forming poorly defined plaques with lichenification, symmetrically distributed on the face, extensor areas (elbows, knees), and hands.

Question 2

What does lichenification indicate in a rash?

Answer 2

Thickened skin due to chronic scratching

Question 3

What is the most likely diagnosis for this child?

Answer 3

Atopic eczema (atopic dermatitis).

Question 4

At what age does atopic eczema commonly present?

Answer 4

Usually before age 5, often in infancy or early childhood.

Question 5

What is the typical course of atopic eczema?

Answer 5

Chronic, relapsing-remitting, with periods of flare-ups and remissions.

Question 6

What is the most prominent symptom of atopic eczema?

Answer 6

Intense pruritus (itching).

Question 7

What additional features support the diagnosis of atopic eczema in this child?

Answer 7

Nasal sparing

Dennie–Morgan lines (extra skin fold under the eyes)

Allergic shiners (dark circles around the eyes)

Question 8

What triggers should be avoided to help manage atopic eczema?

Answer 8

Harsh soaps, detergents, perfumes

Wool or rough fabrics

Excessive heat and sweat

Environmental allergens such as dust, pets, and pollen

Question 9

What type of cleansers should be used for children with atopic eczema?

Answer 9

Fragrance-free, mild cleansers with lukewarm baths.

Question 10

How should moisturization be performed in atopic eczema?

Answer 10

Apply thick emollients (e.g., petroleum jelly, ceramide creams) multiple times a day, especially after bathing.

Question 11

What clothing and environmental measures help manage atopic eczema?

Answer 11

Dress the child in soft cotton clothing

Avoid overheating

Keep nails short to prevent scratching and secondary infection

Question 12

What is Step 1: Basic Skin Care in atopic eczema management?

Answer 12

Daily emollients (moisturizers) applied 2–3 times a day

Oatmeal or bleach baths if recurrent infections occur

Question 13

What is Step 2: Anti-inflammatory Treatment for mild to moderate eczema?

Answer 13

Low-potency topical steroids:
- Face: Hydrocortisone 1% or Desonide
- Body: Betamethasone valerate 0.05%

Apply twice daily for up to 2 weeks, then taper down

Question 14

What is Step 2 treatment for severe eczema?

Answer 14

Stronger topical steroids: e.g., Mometasone furoate 0.1%

Short courses of topical calcineurin inhibitors (Tacrolimus, Pimecrolimus) for sensitive areas like face and eyelids

Question 15

How is itching managed in atopic eczema?

Answer 15

Oral antihistamines (e.g., Cetirizine, Loratadine) at night to reduce scratching

Question 16

Why are emollients important in eczema management?

Answer 16

They restore the skin barrier, reduce dryness, and prevent flare-ups

Question 17

What is impetiginization in atopic eczema?

Answer 17

Secondary bacterial infection, usually caused by Staphylococcus aureus or Streptococcus pyogenes, complicating eczema.

Question 18

What are the clinical signs of impetiginized eczema?

Answer 18

Crusting, oozing, and pustules on affected skin.

Question 19

How is mild impetiginization treated?

Answer 19

With topical antibiotics such as Mupirocin.

Question 20

How is severe impetiginization or infection with systemic signs treated?

Answer 20

With oral antibiotics such as Flucloxacillin or Cephalexin.

Question 21

What is eczema herpeticum?

Answer 21

A superinfection of eczema with Herpes Simplex Virus (HSV), considered a medical emergency.

Question 22

What are the signs of eczema herpeticum?

Answer 22

Painful, punched-out vesicles, fever, and widespread worsening of eczema.

Question 23

How is eczema herpeticum treated?

Answer 23

Immediate oral Acyclovir; hospital referral if severe.

Question 24

How do the lesions present in this 14-month-old child?

Answer 24

As clusters of erythematous vesicles and papules.

Question 25

What is the most likely diagnosis for clusters of erythematous vesicles and papules.

Answer 25

Papular urticaria due to insect bites

Question 26

What is a useful diagnostic sign in babies for papular urticaria?

Answer 26

Nappy sparing — lesions typically avoid the diaper area.

Question 27

What general preventive measures should be taken for papular urticaria ?

Answer 27

Treat pets regularly for fleas Check mattresses for bedbugs Fumigate the home if necessary

Question 28

What are the specific treatments for papular urticaria?

Answer 28

Topical corticosteroids, including wet wraps for severe lesions 5% LPC in HEB Antihistamines for itching Topical or systemic antibiotics if lesions are infected

Question 29

How would you describe the morphology of the rash? Baby with Rash in Groin and Scalp

Answer 29

Erythematous patch or plaque with greasy scaling, located in axilla, groin, and scalp.

Question 30

What is the most likely diagnosis for this baby? Baby with Rash in Groin and Scalp

Answer 30

Seborrhoeic eczema (seborrhoeic dermatitis).

Question 31

Why is seborrhoeic eczema the diagnosis in this case?

Answer 31

Because of: Greasy, erythematous patches Typical distribution: scalp, groin, axilla Poor response to aqueous cream (common in atopic eczema management)

Question 32

What are the main conditions to consider in a diaper area rash?

Answer 32

Seborrhoeic eczema Candidal diaper dermatitis Irritant contact dermatitis Atopic dermatitis Psoriasis

Question 33

What are the features of seborrhoeic eczema in the diaper area?

Answer 33

Erythematous plaques with greasy scales, often involving scalp, axillae, and skin folds, usually non-itchy

Question 34

How does candidal diaper dermatitis differ from seborrhoeic eczema?

Answer 34

Bright red rash with satellite pustules Often spares skin folds Responds well to antifungal treatment

Question 35

How does irritant contact dermatitis present in the diaper area?

Answer 35

Shiny, red, well-demarcated rash over convex surfaces, usually spares skin folds, worsened by prolonged diaper exposure.

Question 36

What features suggest atopic dermatitis in the diaper area?

Answer 36

Dry, scaly, itchy patches, more common on extensor surfaces, with intense itching.

Question 37

How can psoriasis be differentiated in infants?

Answer 37

Well-demarcated, thick plaques with silvery scale, less common in infants, may have family history of psoriasis.

Question 38

What general skin care measures should be advised?

Answer 38

Stop aqueous cream (can be irritating) Use emollients like petroleum jelly or fragrance-free moisturizers

Question 39

How is mild inflammation treated in infant seborrhoeic eczema?

Answer 39

Low-potency topical steroids (e.g., 1% hydrocortisone) applied to affected areas

Question 40

How should scalp involvement be managed?

Answer 40

Apply baby oil or mineral oil overnight, then gently brush off scales Use ketoconazole 2% shampoo if severe

Question 41

How should diaper area involvement be managed?

Answer 41

Keep the area clean and dry, with frequent diaper changes Apply zinc oxide barrier cream If candida superinfection is suspected, use topical antifungal cream (e.g., clotrimazole)

Question 42

What reassurance can be given to parents?

Answer 42

Infantile seborrhoeic dermatitis is self-limiting, usually resolves by 6–12 months