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You are an F1 working in a GP practice. Your next patient is a eight month old girl, named Bea Eneff, whose mother reports a red rash over her cheeks and chin.

Please take a history from her mother and examine Bea, reporting your findings to the examiner. You will then be asked to discuss the case with the examiner.

You are Tee, the mother of Bea Eneff, an eight month old girl who has developed red, itchy rash over her cheeks and chin over the last week. You’re really worried that it’s something serious, like ebola.

HPC: You noticed the rash come up last week. If asked about any triggers, you went to visit your sister last week who has a dog the rash came up not long after this. She has two large red patches over each cheek and some smaller patches over her chin, they stand out really well and are scaly. She keeps scratching at her cheeks and crying, so you think they must be very itchy. You have tried putting some Vaseline on but this did not help. You have not started using any new cleaning products or detergents. She has been otherwise well with no rash elsewhere, any fevers, cough, diarrhoea or vomiting. She has been eating and drinking as normal. You’ve heard that viruses and things can cause rashes, and are worried because your partner came back from Spain last week and has been vomiting – could he have picked up ebola in the airport and given it to poor Bea? PMH: She had bronchiolitis when she was 3 months old for which she spent a night in hospital, requiring oxygen. She is otherwise fit and well. She is developing normally and is up to date on her immunisations.

BH: Bea was born at 39 weeks in a spontaneous vaginal delivery and weighed 7lb 9oz. She required no extra medical care after birth and you had no complications in the pregnancy.

DH: None. She has no known drug allergies.

FH: You suffered from asthma as a child and her older sibling gets bad hay fever every spring. There is no other relevant family history.

SH: Bea lives at home with you, your husband and her older sister who is six years old. Your husband is a plumber and you do not work. The only pets you have are two goldfish called Ant and Dec, you would have liked to get a cat but animal fur can set off your eldest daughters allergies. Your husband smokes but he always opens the back door when he does so.

ICE: You are not really sure what could be causing this rash, you are worried it might be some sort of infection. You are concerned because it looks really bad and it’s clearly very uncomfortable for Bea. You are especially worried that it might be permanent or leave a scar. You want to know what it is and maybe get some cream to get rid of it.

Please observe the student take a history from this patient. Ask them to present their findings and list their differentials, which should include eczema. An excellent candidate will identify Tee’s concerns and reassure her appropriately.

Topics for discussion: • What are some of the predisposing factors for childhood eczema? • What are some of the potential triggers for childhood eczema? • How would you manage this patient? • What advice would you give to this parent? • How might childhood eczema differ from eczema in adults? • In an adult, how can you differentiate between eczema and psoriasis?