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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

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.

Scenario

Sammy is a four-month-old boy who has an itchy rash.

The following information is on his summary sheet:

  • Past medical history

  • Normal vaginal delivery following uncomplicated pregnancy

  • Medication

  • Nil prescribed

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Family history

  • Mother asthmatic and allergic rhinitis

  • Father eczema as a baby.

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:

  • Past medical history

  • Normal vaginal delivery following uncomplicated pregnancy

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Family history

  • Mother asthmatic and allergic rhinitis

  • Father eczema as a baby.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Explore Jessica’s ideas, concerns and expectations.

Specific questions

Duration of the rash

Site of the rash

Scratching

Precipitating and relieving factors

Impact on Sammy and family

Previous treatment tried

Current treatment—including use of soaps

Request permission to examine.

Examination

Expose down to nappy

  • — Dry skin with excoriations

  • — Widespread patches of eczema

  • — Exclude secondary infection.

Diagnosis

Eczema

Plus possible contact allergy to tea-tree oil.

Management

Discuss and explain the diagnosis of eczema

Explain that eczema can be controlled but not cured

Often improves as child grows up.

Prevention

Avoid heat

  • — Loose fitting, cotton clothing and bedding

  • — Tepid comfortable bath water preferred over hot water

Avoid prickle and irritants

  • — Wool, nylon, seams and clothing labels

  • — Chlorine, sand and grass

  • — Soaps and bubble baths, perfumed creams or other products

  • — ...

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