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    #1

    Proofreading

    Hi,

    Thank you for proof reading my essay. I feel that I have not made any improvement with my writing for the last 10 years. Every time I write, there are still grammatical errors, would like to get some feedback so that I can continue learning. Thanks



    History


    Edith was a 4 months old baby girl who presented with a lifelong history of generalised itchy rash. Parents reported history of rash soon after birth and had gotten worse over the last few weeks. The rash was disturbing Edith’s sleep at night secondary to the itchiness. It was mainly on her forehead, elbows, knees, feet and torso. The rash seemed to be worse when they switched the heater on at night.


    Edith was born at 39 weeks via normal vaginal birth. There was no antenatal complication. Apgar score after birth was 9 and 9. Edith’s birth weight, height and head circumferences were all at 60th percentile. Mum was breast feeding her 3-4 hourly. The last maternal child health nurse visit 1 week ago was satisfactory and no other concerns were reported from both parents.


    Edith is the first child of the family. Dad works as a full time carpenter and mum works as a chef but currently on maternity leave. Both parents’ families live in town and they have been assisting in caring for Edith during the day so Mum can have a break.


    Mum thought that the rash was eczema and tried paw paw ointment and 1% hydrocortisone cream over the counter. When they bought the 1% hydrocortisone, the pharmacist warned them not to use the topical steroid cream for more than one week. Mum reported that the rash might have responded to hydrocortisone initially but returned soon after she ceased applying it.


    Examination


    General appearance: well looking infant with a macula scaly rash on her forehead and both cheeks. There were excoriation marks over the face
    Weight, height and head circumference were sitting at 60th percentile
    Vital signs: temperature 37, heart rate 110 regular , respiratory rate 30 breaths per minute, capillary refill was less than 2 seconds
    Skin examination: macular scaly rash on bilateral forearms, elbows, forehead, scalp, abdomen, back, knees and feet. The rash appeared to be itchy as there were excoriation marks over the rash and she had been scratching since coming into the consultation room. There was no oozing or discharge coming from the rash to indicate an infective process. On palpation, the rash had a rough texture to it.
    Cardiovascular system: Normal heart sound. Normal radial and femoral pulses. Normal chest auscultation.
    Gastrointestinal system: No evidence of malnourishment. Abdomen was soft on palpation and no evidence of organomegaly.


    Investigations


    No investigation was performed


    A Provisional diagnosis of eczema was made


    Differential diagnoses

    • eczema
    • psoriasis
    • drug eruption
    • contact dermatitis
    • pityriasis vesicolour
    • viral exanthem



    Investigation was not performed as the diagnosis was clear. If Edith did not respond to initial treatment,




    Management


    The diagnosis was given and explained to both parents. A handout on the topic of eczema from The Royal Children’s hospital in Victoria was given to parents. Management advice was given according to The Royal Children Hospital eczema treatment guideline. Parents were instructed to avoid environmental triggers such as heat and prickly/rough material, moisturise Edith’s skin at least twice per day using QV moisturising cream or equivalent, advantan fatty ointment was prescribed to apply daily on the area of the skin which felt rough on palpation, and continue using the ointment on the areas until the skin felt normal again. Wet dressing was also prescribed to use on arms and legs at night for comfort and maximise the control of eczema.


    A significant amount of the consultation time was used to re-assure the parents that topical steroid is safe to use in children and it can be used for more than seven days without any significant side effects.


    Patient was reviewed after 1 week. Parents still were hesitant to apply advantan fatty ointment on face. Wet dressing was also not performed because parents were satisfied with partial improvement from topical cortical steroid (TCS). On examination, there were less excoriation marks on the face. There were still inflamed skin on bilateral knees and arms but they had improved from the last consultation. The rash in the other areas had largely settled down. Further education was given to parents regarding wet dressing and the safety profile of TCS and another follow up appointment was scheduled in 2 weeks.


    Discussion


    Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. A core component of therapy is to manage the inflammation with TCS. However, topical steroids are often under-utilised because of corticosteroid phobia and unfounded concerns about their adverse effects. In my own experience, this fear is often populated by pharmacists, and occasionally by general practitioners and even general paediatricians. Last year the Australasian college of dermatologists published a consensus statement on the adverse effects of topical corticosteroids in paediatric eczema and in that it stated that TCS should be the cornerstone treatment of atopic eczema. When TCS is used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal.


    The most feared side effects from other health professionals is skin atrophy. In one study (4), 67% of pharmacists participated in the study reported telling patients not to use TCS for more than 2 weeks as it can potentially cause skin atrophy. The consensus statement published by the college of dermatologists in Australasia stated that irreversible skin thinning does not occur when TCS, used for eczema in children, is stopped on resolution of the dermatosis. (1)


    This case highlights that how deep seeded some of the false beliefs about TCS can be among parents. These false beliefs can be a major barrier in adequate control of eczema so they need to be addressed accordingly. It is worthwhile spending time with parents and teach them about the nature of eczema, the management principles and the safety profile of TCS. Particular emphasis should be put on addressing parental safety concerns on TCS.


    Sometimes despite the correct use of TCS, patient may still return with treatment failure. Page et al (2016) listed some potential possibilities in their article, which include psychosocial factors, other triggers such as food allergies, not addressing general measures in eczema management and inadequate education.


    Summary


    Eczema is a common paediatric skin disorder. It is usually not a life threatening condition but it can often cause distress within the family unit. This case and current evidence show that there is a widespread false beliefs concerning the safety of TCS. These concerns need to be addressed and corrected in order to achieve optimum control of eczema. Education to parents and other health professionals in the community will help to improve eczema control in the future.

    • Member Info
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      • England
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    #2

    Re: Proofreading

    Welcome to the forum.

    Please correct the information in your profile.

    We like to think new members are telling us the truth about themselves.
    Last edited by Rover_KE; 24-Aug-2016 at 15:56.

    • Member Info
      • Native Language:
      • English
      • Home Country:
      • England
      • Current Location:
      • England

    • Join Date: Jun 2010
    • Posts: 21,473
    • Post Thanks / Like
    #3

    Re: Proofreading

    Quote Originally Posted by foreverstudent View Post
    Hi,

    Thank you for proof reading my essay. I feel that I have not made any improvement with my writing for the last 10 years. Every time I write, there are still grammatical errors, would like to get some feedback so that I can continue learning. Thanks



    History


    Edith was a 4 months old baby girl who presented with a lifelong history of generalised itchy rash. Parents reported history of rash soon after birth and had gotten worse over the last few weeks. The rash was disturbing Edith’s sleep at night secondary to the itchiness. It was mainly on her forehead, elbows, knees, feet and torso. The rash seemed to be worse when they switched the heater on at night.


    Edith was born at 39 weeks via normal vaginal birth. There was no antenatal complication. Apgar score after birth was 9 and 9. Edith’s birth weight, height and head circumferences were all at 60th percentile. Mum was breast feeding her 3-4 hourly. The last maternal child health nurse visit 1 week ago was satisfactory and no other concerns were reported from both parents.


    Edith is the first child of the family. Dad works as a full time carpenter and mum works as a chef but currently on maternity leave. Both parents’ families live in town and they have been assisting in caring for Edith during the day so Mum can have a break.


    Mum thought that the rash was eczema and tried paw paw ointment and 1% hydrocortisone cream over the counter. When they bought the 1% hydrocortisone, the pharmacist warned them not to use the topical steroid cream for more than one week. Mum reported that the rash might have responded to hydrocortisone initially but returned soon after she ceased applying it.


    Examination


    General appearance: well looking infant with a macula scaly rash on her forehead and both cheeks. There were excoriation marks over the face
    Weight, height and head circumference were sitting at 60th percentile
    Vital signs: temperature 37, heart rate 110 regular , respiratory rate 30 breaths per minute, capillary refill was less than 2 seconds
    Skin examination: macular scaly rash on bilateral forearms, elbows, forehead, scalp, abdomen, back, knees and feet. The rash appeared to be itchy as there were excoriation marks over the rash and she had been scratching since coming into the consultation room. There was no oozing or discharge coming from the rash to indicate an infective process. On palpation, the rash had a rough texture to it.
    Cardiovascular system: Normal heart sound. Normal radial and femoral pulses. Normal chest auscultation.
    Gastrointestinal system: No evidence of malnourishment. Abdomen was soft on palpation and no evidence of organomegaly.


    Investigations


    No investigation was performed


    A Provisional diagnosis of eczema was made


    Differential diagnoses

    • eczema
    • psoriasis
    • drug eruption
    • contact dermatitis
    • pityriasis vesicolour
    • viral exanthem



    Investigation was not performed as the diagnosis was clear. If Edith did not respond to initial treatment,




    Management


    The diagnosis was given and explained to both parents. A handout on the topic of eczema from The Royal Children’s hospital in Victoria was given to parents. Management advice was given according to The Royal Children Hospital eczema treatment guideline. Parents were instructed to avoid environmental triggers such as heat and prickly/rough material, moisturise Edith’s skin at least twice per day using QV moisturising cream or equivalent, advantan fatty ointment was prescribed to apply daily on the area of the skin which felt rough on palpation, and continue using the ointment on the areas until the skin felt normal again. Wet dressing was also prescribed to use on arms and legs at night for comfort and maximise the control of eczema.


    A significant amount of the consultation time was used to re-assure the parents that topical steroid is safe to use in children and it can be used for more than seven days without any significant side effects.


    Patient was reviewed after 1 week. Parents still were hesitant to apply advantan fatty ointment on face. Wet dressing was also not performed because parents were satisfied with partial improvement from topical cortical steroid (TCS). On examination, there were less excoriation marks on the face. There were still inflamed skin on bilateral knees and arms but they had improved from the last consultation. The rash in the other areas had largely settled down. Further education was given to parents regarding wet dressing and the safety profile of TCS and another follow up appointment was scheduled in 2 weeks.


    Discussion


    Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. A core component of therapy is to manage the inflammation with TCS. However, topical steroids are often under-utilised because of corticosteroid phobia and unfounded concerns about their adverse effects. In my own experience, this fear is often populated by pharmacists, and occasionally by general practitioners and even general paediatricians. Last year the Australasian college of dermatologists published a consensus statement on the adverse effects of topical corticosteroids in paediatric eczema and in that it stated that TCS should be the cornerstone treatment of atopic eczema. When TCS is used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal.


    The most feared side effects from other health professionals is skin atrophy. In one study (4), 67% of pharmacists participated in the study reported telling patients not to use TCS for more than 2 weeks as it can potentially cause skin atrophy. The consensus statement published by the college of dermatologists in Australasia stated that irreversible skin thinning does not occur when TCS, used for eczema in children, is stopped on resolution of the dermatosis. (1)


    This case highlights that how deep seeded some of the false beliefs about TCS can be among parents. These false beliefs can be a major barrier in adequate control of eczema so they need to be addressed accordingly. It is worthwhile spending time with parents and teach them about the nature of eczema, the management principles and the safety profile of TCS. Particular emphasis should be put on addressing parental safety concerns on TCS.


    Sometimes despite the correct use of TCS, patient may still return with treatment failure. Page et al (2016) listed some potential possibilities in their article, which include psychosocial factors, other triggers such as food allergies, not addressing general measures in eczema management and inadequate education.


    Summary


    Eczema is a common paediatric skin disorder. It is usually not a life threatening condition but it can often cause distress within the family unit. This case and current evidence show that there is a widespread false beliefs concerning the safety of TCS. These concerns need to be addressed and corrected in order to achieve optimum control of eczema. Education to parents and other health professionals in the community will help to improve eczema control in the future.
    Post quoted in case of subsequent deletion.

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