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Discoid Eczema — SCE Dermatology MCQ

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EasyInflammatory DermatosesDiscoid EczemaSCE Dermatology

A 35-year-old woman with discoid eczema has coin-shaped plaques on her lower legs that are not responding to moderate potency topical corticosteroids. What is the appropriate treatment escalation?

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Correct answer: D — Escalate to potent topical corticosteroid under occlusion

For discoid (nummular) eczema not responding to moderate potency topical corticosteroids, treatment escalation to potent topical corticosteroids (e.g., Betamethasone valerate 0.1% or Mometasone furoate 0.1%) is appropriate. Application under occlusion (cling film or hydrocolloid dressing) enhances penetration for thick lichenified plaques. If secondary infection is suspected (crusting, weeping, golden exudate), combination with topical or oral antibiotics is warranted. Patch testing should be considered if treatment resistance persists, as contact allergy (including to topical corticosteroid or emollient ingredients) may be contributing. NB-UVB phototherapy is an option for widespread disease.

Reference: BAD 2019; NICE CKS Eczema