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Atopic Eczema — SCE Dermatology MCQ

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EasyInflammatory DermatosesAtopic EczemaSCE Dermatology

A 35-year-old woman with moderate atopic eczema flare has been using emollients and moderate topical corticosteroids without adequate response. Her dermatologist considers stepping up treatment. According to NICE stepped approach, what is the next step?

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Correct answer: E — Potent topical corticosteroid

NICE CG57 stepped approach for atopic eczema: Step 1 — Emollients; Step 2 — Mild topical corticosteroid (face/flexures) or moderate potency (body); Step 3 — Potent topical corticosteroid (short courses, body only); Step 4 — Specialist referral for phototherapy, systemic immunosuppression (Ciclosporin, Methotrexate, Azathioprine, Mycophenolate), or biologics (Dupilumab, JAK inhibitors). The question describes inadequate response to moderate potency — escalation to potent topical corticosteroid is the appropriate next step before considering systemic therapy. Bandaging or wet wraps may enhance topical treatment efficacy at this stage.

Reference: NICE 2007 CG57 (updated 2023); BAD AD Guidelines