DR12.1-2 | Eczema Recognition and Basic Treatment — Summary & Reflection

KEY TAKEAWAYS

Eczema is the commonest itchy dermatosis you will meet, and recognising its type guides everything. It is classified by cause into endogenous (atopic, seborrhoeic, nummular, pompholyx, stasis, asteatotic) and exogenous (irritant and allergic contact dermatitis), and by phase into acute (vesicular, oozing) and chronic (lichenified). Atopic eczema is flexural in children and adults; allergic contact dermatitis is a type IV reaction confirmed by patch testing; irritant contact dermatitis needs only sufficient exposure. Always exclude tinea (KOH mount) and psoriasis (Auspitz sign, extensor plaques). Treatment is a ladder on an emollient foundation: emollients, then topical corticosteroids matched to site by the potency ladder (mild only on face/flexures), topical calcineurin inhibitors as steroid-sparing agents, antihistamines for itch, antibiotics for secondary infection, and systemic therapy for severe refractory disease. The cardinal safety rule is never to use potent or combination steroid creams on the face.

REFLECT

Think of a patient or family member you know who has used a skin cream bought directly from a pharmacy for an itchy rash on the face. Knowing what you now know about topical steroid potency and the harms of combination creams, how would you have counselled them differently? Reflect on how you will explain to future patients — in plain language — why a cream that 'works fast' on the face can cause lasting harm, and why emollients and the right-strength steroid are the safer path.