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Atopic Eczema — SCE Dermatology MCQ

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HardPaediatric DermatologyAtopic EczemaSCE Dermatology

Parents of a child with recurrent clinically infected eczema ask whether twice-weekly 0.005% sodium-hypochlorite baths should be prescribed as a proven stand-alone decolonisation treatment. What does current NICE evidence support?

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

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Correct answer: A — Evidence remains insufficient because the small trial combined intranasal mupirocin and dilute bleach bathing

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

B is correct. NICE found one small trial comparing intranasal mupirocin plus a 0.005% bleach bath, used for 5 to 10 minutes twice weekly, with placebo. Because the components were not tested separately, the trial did not establish that bleach baths alone are effective, and NICE made no recommendation for routine antiseptic bath-emollient use. A overstates certainty and would undertreat inflammation. C ignores chemical-injury risk and evidence-specific concentration. D invents a negative-swab prerequisite. E also makes an unsupported component-specific inference. Clinically infected eczema and the underlying flare should still be managed according to severity and antimicrobial guidance.

Reference: NICE NG190 rationale and impact: https://www.nice.org.uk/guidance/ng190/chapter/rationale-and-impact