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Atopic and contact dermatitis
Atopic eczema is a chronic disease of a damaged skin barrier and itch; the basis is a daily emollient, and flares are treated with a topical steroid of a strength suited to the site — not with oral steroids.
Why it matters in the exam
The exam describes an infant with eczema on the cheeks, a child whose flare returns quickly after oral steroids (rebound), and an adult with a burning rash on the hands after an exposure. It asks about the right treatment for the face and folds, an infective complication, and the difference between irritant and allergic contact dermatitis.
Eczema herpeticum — widespread punched-out vesicles on eczema with fever — is an emergency treated with aciclovir.
Eczema harms the sleep, concentration and quality of life of the child and the parents, so a key part of treatment is practical teaching: how much cream to apply, where, for how long, and why the emollient continues when the skin looks normal. Fear of topical steroids is a common cause of treatment failure.
Another recurring question is the difference between infant eczema and seborrhoeic dermatitis ("cradle cap") — yellowish scalp scales that do not itch and are treated with oil and a gentle shampoo. In hand dermatitis of people in wet occupations — nurses, hairdressers and food workers — ask about the job, because changed habits and suitable gloves are part of the treatment. When the rash recurs despite protection, patch testing identifies the allergen.
Key points
- The basis — a daily emollient.
- Flare — topical steroid by site; face and folds — mild or a calcineurin inhibitor.
- Proactive twice-weekly treatment prevents flares.
- Eczema herpeticum — aciclovir, an emergency.
- Allergic contact — 48–72 hours, patch testing.
Summary table
| Condition | Presentation | Treatment | Exam note |
|---|---|---|---|
| Atopic eczema in an infant | Cheeks, extensor surfaces, itch | Emollient, mild steroid | The nappy area is usually spared |
| Atopic eczema in a child and adult | Elbow and knee folds, thickened skin | Emollient, moderate steroid on the body; calcineurin inhibitors on the face and folds | "Proactive" twice-weekly treatment prevents flares |
| Severe eczema | Failure of topical treatment | Phototherapy, dupilumab, JAK inhibitors | Oral steroids — not as routine treatment |
| Eczema herpeticum | Punched-out vesicles and erosions, fever | Aciclovir at once | Emergency |
| Irritant contact dermatitis | Hands, wet work, soap | Protection, gloves, emollient | The most common in the workplace |
| Allergic contact dermatitis | 48–72 hours after contact; nickel, fragrances, plants | Avoid the allergen, topical steroid | Diagnosed by patch testing |
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Sources
- American Academy of Dermatology, 2023 — Guidelines of care for the management of atopic dermatitis in adults with topical therapies
- AAAAI/ACAAI Joint Task Force, 2023 — Atopic dermatitis (eczema) guidelines
- NICE clinical guideline CG57, 2007 (updated 2023) — Atopic eczema in under 12s: diagnosis and management
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.