Case Information
- Case ID: ECZ-011
- Patient Name: Olivia Matthews
- Age: 7
- Gender: Female
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: S87 – Eczema/Dermatitis
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Establishing rapport with the child and parent, providing clear education about eczema triggers and management |
| 2. Clinical Information Gathering and Interpretation | Taking a structured history to assess the pattern, severity, and triggers of eczema |
| 3. Diagnosis, Decision-Making and Reasoning | Differentiating atopic eczema from contact dermatitis, allergic reactions, or infections |
| 4. Clinical Management and Therapeutic Reasoning | Developing an evidence-based management plan, including skincare, topical treatments, and avoidance of triggers |
| 5. Preventive and Population Health | Educating on long-term eczema control, flare prevention, and avoiding complications |
| 6. Professionalism | Ensuring a patient-centred approach, addressing parental concerns, and considering the impact on quality of life |
| 7. General Practice Systems and Regulatory Requirements | Ensuring appropriate prescription of PBS-listed medications and coordinating referrals when needed |
| 9. Managing Uncertainty | Recognising when specialist referral is required, such as suspected food allergies or severe eczema |
| 10. Identifying and Managing the Patient with Significant Illness | Identifying secondary infections or severe eczema requiring more intensive management |
Case Features
- 7-year-old girl presenting with itchy, dry, red skin patches on her elbows, knees, and face for the past 6 months.
- Symptoms worsen in cold weather and after swimming.
- History of asthma and hay fever, suggesting an atopic tendency.
- No recent infections, fever, or weeping lesions, but scratching leads to occasional skin breaks.
- Parents are concerned about persistent symptoms despite using moisturiser.
Candidate Information
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: Olivia Matthews
- Age: 7
- Gender: Female
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- Nil regular medications
- Uses moisturiser daily
Past History
- Diagnosed asthma (mild intermittent)
- Diagnosed hay fever (allergic rhinitis)
Social History
- Lives with parents and two younger siblings
- Attends primary school, no known school-related allergies
- No pets at home
Family History
- Mother has eczema
- Father has asthma
Vaccination and Preventive Activities
- All childhood immunisations up to date
Scenario
Olivia Matthews, a 7-year-old girl, presents with a 6-month history of itchy, dry, red skin patches affecting her elbows, knees, and face. The symptoms worsen in winter and after swimming.
She has a personal and family history of atopy (asthma and hay fever). Moisturiser has provided limited relief, and her parents are concerned about persistent itching and scratching.
On examination:
- General appearance: Well, no signs of systemic illness
- Skin findings:
- Erythematous, dry, scaly patches on elbows, knees, and face
- Excoriation marks from scratching but no pus or crusting
- No widespread rash or urticaria
- Respiratory: No wheeze or respiratory distress
Likely Diagnosis: Atopic Dermatitis (Eczema)
Examiner Only Information
Questions
Q1. How would you differentiate atopic eczema from other skin conditions?
- Prompt: What features suggest atopic eczema?
- Prompt: How would you differentiate it from contact dermatitis or fungal infections?
Q2. How would you manage Olivia’s eczema?
- Prompt: What are the first-line treatments?
- Prompt: When should topical corticosteroids be used?
Q3. What advice would you give Olivia’s parents about daily skincare?
- Prompt: What are the key principles of eczema care?
- Prompt: How do you prevent flare-ups?
Q4. What red flags would prompt further investigations or referral?
- Prompt: When would you suspect secondary infection?
- Prompt: When would referral to a dermatologist or allergist be needed?
Q5. How would you address parental concerns about steroid creams?
Prompt: What alternative treatments might be considered?
Prompt: How do you explain the safety of topical corticosteroids?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1. How would you differentiate atopic eczema from other skin conditions?
The competent candidate should:
- Identify characteristic features of atopic eczema:
- Chronic, relapsing pruritic rash affecting flexural areas (elbows, knees) and face.
- Personal or family history of atopy (asthma, allergic rhinitis, eczema).
- Worse in response to environmental triggers (cold weather, irritants like soap).
- Differentiate from other conditions:
- Contact dermatitis: Localised rash following exposure to an irritant/allergen, improves with avoidance.
- Fungal infections: Well-defined, scaly, ring-shaped lesions, confirmed by skin scrapings.
- Psoriasis: Well-demarcated, thick plaques with silvery scale, often affecting extensor surfaces.
- Scabies: Intense itching, worse at night, burrows in web spaces.
- Assess for secondary bacterial infection:
- Presence of weeping, crusting, or pustules suggests secondary infection (impetigo).
SUMMARY OF A COMPETENT ANSWER
- Recognises typical atopic eczema presentation (chronic, itchy, flexural rash, atopy).
- Differentiates from contact dermatitis, fungal infections, and psoriasis.
- Identifies secondary infection requiring further management.
- Considers skin scrapings if diagnostic uncertainty remains.
PITFALLS
- Misdiagnosing contact dermatitis as eczema and not addressing triggers.
- Failing to assess for infection in a worsening, weeping rash.
- Overlooking other conditions, such as scabies or fungal infections.
- Not recognising the impact of atopy on skin barrier dysfunction.
REFERENCES
- RACGP Atopic Eczema Guidelines
- Australian Society of Dermatology on Eczema Management
- Therapeutic Guidelines on Dermatology – Eczema
MARKING
Each competency area is on the following scale from 0 to 3.
☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated
1. Communication and Consultation Skills
1.1 Communicates appropriately with the child and parents.
1.3 Engages the family to explore concerns about the condition.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured history to assess eczema severity and triggers.
2.3 Differentiates atopic eczema from other dermatological conditions.
3. Diagnosis, Decision-Making and Reasoning
3.1 Identifies key clinical features supporting an eczema diagnosis.
3.5 Uses clinical reasoning to determine appropriate investigations and treatment.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD