Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Adult eczema

Clinical Discipline(s)/Organ System(s)
Dermatology, Immunology
Progress Test Topic(s)
A 23 year old NZ European woman with lifelong atopic dermatitis presents to her GP with a rash on her hands 6 months after starting her apprenticeship as a hairdresser. She gives a history of having a rash at the site of costume jewellery (e.g. earrings).
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the epidermis and dermis
   - Pathogenesis of atopic eczema including impairment of the skin barrier function and its subsequent vulnerability to irritants and antigens
   - Multifactorial pathogenesis of hand dermatitis
   - Immunology of allergic contact dermatitis
   - Pharmacology of topical and systemic anti-inflammatory corticosteroids
Clinical and Communication Skills 
   - Take an occupational history where relevant to skin disease
   - Establish what treatments are being used and the quantities used. Is there 'steroid phobia?'
   - Undertake a careful and full skin examination
   - Describe cutaneous features using dermatological terminology
   - Investigate appropriately with referral for patch testing. Consider other differential diagnoses
   - Advise about antigen/irritant avoidance, appropriate topical or systemic therapy (if needed). Give specific written and verbal instructions about management plan (topical steroid use including potency and quantities, frequency and duration)
Personal and Professional Skills 
   - Provide a long-term care plan and establish a therapeutic relationship
   - Be able to tactfully advise about career choice or change
Hauora Māori 
   - Awareness of differing risk profiles for atopy between Māori (and other disadvantaged populations) compared with non-Māori in New Zealand
   - Acknowledgement of the disproportionate impact of illness on whānau employment/income
Population Health 
   - Appropriate career advice to patients with skin disease
Conditions to be considered relating to this scenario
irritant contact dermatitis, allergic contact dermatitis, tinea corporis, lichen simplex chronicus
Less common but 'important not to miss'
cutaneous T cell lymphoma
Related Scenarios
[Blisters], [Itching child]