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S. aureus Eczema — SCE Dermatology MCQ

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HardInflammatory DermatosesS. aureus EczemaSCE Dermatology

An adult with atopic eczema has increased weeping and crusting but no fever, malaise, spreading erythema or rapidly worsening pain. Swabbing during a previous flare grew Staphylococcus aureus. What is the best initial plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Continue emollients and topical corticosteroids; reserve antibiotics for clinical infection

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

B is correct. Eczema is frequently colonised with S. aureus, and crusting or weeping alone does not reliably identify bacterial infection. NICE advises that a person who is not systemically unwell should not routinely receive an antibiotic because benefit is limited and resistance is a concern; the underlying flare should still be treated with emollients and topical corticosteroids. Flucloxacillin is reserved for clinically infected disease when an oral antibiotic is indicated. Repeated fusidic acid promotes resistance, stopping anti-inflammatory treatment worsens barrier disease, and previous colonisation does not justify intravenous therapy.

Reference: NICE NG190 infected eczema recommendations: https://www.nice.org.uk/guidance/ng190/chapter/Recommendations