February Week 3 (by Dr Dixon)


A mother brings her 3 year old in for an “eczema outbreak”; she states
her child, who has eczema, has been scratching at the rash on her
right cheek so much that it has become “crusty and oozy”. She is
concerned because she has never seen it like this before. She has
only previously had outbreaks on the extensor surfaces of her arms.
She has never had an outbreak that looks like this before; previously,
the areas remained red.

On exam, the patient has a round, approximately 2 inch wide circular
erythematous plaque covered by yellow crusts. The child constantly
tries to itch it.

1) What are the diagnostic criteria for eczema? How strictly do we
adhere to such criteria in practice?

2) Mom asks you to review the pathophysiology of eczema. “What
happens when she gets these flares?” she asks. How do you respond?

3) What would you recommend for treatment? For daily treatment after
this exacerbation resolves?

4) Mom asks for advice on prevention of flares? What do you
recommend? What should she avoid?