GPs' experiences of diagnosing and managing childhood eczema: a qualitative study in primary care.

BACKGROUND: Eczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition. AIM: To explore the experiences of GPs in assessing and managing children with eczema. DESIGN AND SETTING: Qualitative study in primary care in England. METHOD: Semi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method. RESULTS: GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy. CONCLUSION: GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.

Meyerson phenomenon.

BACKGROUND: Meyerson phenomenon is an uncommon clinical condition that is characterized by an eczematous halo surrounding a preexisting melanocytic nevus and numerous other lesions. The etiology of this condition is unknown. We suggest that the mechanism is due to the interaction between CD4 T lymphocytes and increased expression of intercellular cell adhesion molecule 1 (ICAM-1). OBJECTIVE: This article provides a concise overview of Meyerson phenomenon. METHODS AND RESULTS: We present the case of a 37-year-old female with an inflamed nevus located on her thigh from no evident cause. Her condition resolved with surgical excision of the nevus. Histopathology of the specimen demonstrated spongiosis and lymphocytic infiltrate with eosinophils, which confirmed the diagnosis of Meyerson phenomenon. CONCLUSION: Meyerson phenomenon can resolve spontaneously or with treatment of either topical steroids or surgical excision. The main concern with benign lesions presenting with inflammation is malignant transformation; thus, clinicians need to be more aware of Meyerson phenomenon.

Refractory eczematous dermatitis associated with retained suture material.

We present a patient who developed a cutaneous-id reaction and eczematous dermatitis related to a residual Prolene suture following excision of dermatofibrosarcoma protuberans. Following a wider excision of the site, with removal of the retained suture material, the patient's symptoms dramatically improved. Although this reaction is rare, retained sutures should be considered a possible cause of a postoperative eczematous dermatitis that does not respond to standard therapies.

Halo eczema--resolution after excision of the central naevus alone.

We describe a patient with halo eczema around a benign pigmented compound naevus. The eczema resolved after excision of the central naevus alone; this allowed histological assessment of the naevus without the need for a large excision or for additional topical therapy.