Maggie, an eight-year-old with impetiginised eczema, is brought in by her parents.

She has inflamed, excoriated, lichenified patches, with evidence of ooze and yellow crusting to both elbow and knee creases, as well as lichenified, scaly fissured areas with excoriations around both ankles and the abdomen.

Maggie is systemically well, and growth and development are within expected range. Maggie has had eczema since childhood, with no evidence of other atopic manifestations.

She has been treated for impetigo several times previously, with a good response to a course of oral antibiotics, prescribed along- side potent steroids to control the background eczema.