Infected eczema — DCH MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic conditionsInfected eczemaDCH

A 5-year-old with established atopic eczema develops a rapidly worsening flare with increased itch, weeping, pustules and yellow crusting in the flexures. Her temperature is 37.7°C, and she is alert. The lesions are not painful, and there are no clustered vesicles or punched-out erosions. What is the most likely diagnosis?

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

Reveal the answer and explanation

Correct answer: C — Secondary bacterial infection of eczema

The answer is C. Rapid worsening of established eczema with weeping, pustules and yellow crusting is characteristic of secondary bacterial infection, commonly involving staphylococci or streptococci. Eczema herpeticum is the important near miss, but it more typically causes painful, rapidly worsening eczema with clustered vesicles or uniform punched-out erosions, sometimes with fever, lethargy or distress. Scabies usually causes marked, often nocturnal itch with burrows and characteristic involvement of sites such as the finger webs. Urticaria produces transient wheals rather than crusted lesions, while psoriasis typically causes well-demarcated scaly plaques. Emollients and appropriate topical corticosteroids should be continued; the need for antibiotics is assessed separately because they are not routinely required in a child who is not systemically unwell.

Reference: NICE. Atopic eczema in under 12s: diagnosis and management (CG57), recommendations 1.5.1.36 and 1.5.1.42. Published 2007; updated 2025. https://www.nice.org.uk/guidance/cg57/chapter/recommendations