INSTRUCTIONS FOR THE DOCTOR
Please take a history from Jessica, Sammy’s mum. A clinical photograph of Sammy’s skin problem will be available for you on request. (Refer to Figure 2) Please discuss the diagnosis with Jessica and advise on the management of the condition.
Sammy is a four-month-old boy who has an itchy rash.
The following information is on his summary sheet:
INSTRUCTIONS FOR SAMMY’S MOTHER, JESSICA BURNSIDE
You had a busy life as a teacher at the local preschool. You are on maternity leave following Sammy’s birth but are soon due to return to work. Sammy has had an itchy rash on his face, arms, legs and trunk for a few weeks. You’ve been using creams your Mum bought for you, plus tea-tree oil. You hate seeing your beautiful baby so distressed by the scratching and are worried about the thought of putting Sammy into child care when you return to work. You have asthma and allergic rhinitis and your partner had eczema as a baby.
The following information is on Sammy’s medical record:
SUGGESTED APPROACH TO THE CASE
Explore Jessica’s ideas, concerns and expectations.
Precipitating and relieving factors
Impact on Sammy and family
Current treatment—including use of soaps
Request permission to examine.
— Dry skin with excoriations
— Widespread patches of eczema
— Exclude secondary infection.
Plus possible contact allergy to tea-tree oil.
Discuss and explain the diagnosis of eczema
Explain that eczema can be controlled but not cured
Often improves as child grows up.
Avoid prickle and irritants
— Wool, nylon, seams and clothing labels
— Chlorine, sand and grass
— Soaps and bubble baths, perfumed creams or other products