Visible flexural dermatitis – test photographs Do the following series of photographs show visible flexural dermatitis? Adapted from the work of Hywel Williams, MD MARC-35.5 Research Exam

Test photograph 1 Visible dermatitis present around both eyes as per protocol. YES MARC-35.5 Research Exam

Test photograph 2 Dermatitis present behind both knees as per protocol. Easy isn't it? YES MARC-35.5 Research Exam

Test photograph 3 Even though this child has atopic eczema affecting the whole of the neck, face and upper chest, there are numerous patches greater than 1cm in diameter present and there is lichenification (prominent skin creases with thickening of the skin) around the neck. YES MARC-35.5 Research Exam

Test photograph 4 Although this child does indeed have atopic eczema in a "reverse pattern", fronts of the knees are not included in your protocol. NO MARC-35.5 Research Exam

Test photograph 5 There is a patch of dermatitis (with surface oozing and lichenification) present in this boy's elbow crease. YES MARC-35.5 Research Exam

Test photograph 6 This is all dermatitis with lichenification and prominent scaling but front of knees are not allowed in our protocol! NO MARC-35.5 Research Exam

Test photograph 7 This lady has psoriasis. There is a small blotch of erythema behind the right knee but this is probably less than 1cm in diameter and it is well demarcated. This is quite a difficult case to judge from photographs and in real life, you would need to measure the size of the red patches in the designated areas with a ruler or by comparison with a suitable coin. NO MARC-35.5 Research Exam

Test photograph 8 An inflamed skin crack underneath the ears (infra auricular fissure) is quite common in children with severe atopic eczema but this is not a site included in your protocol. NO MARC-35.5 Research Exam

Test photograph 10 This is a little more subtle and shows an older child with chronic atopic eczema in remission. However, there is still ill defined erythema present with prominent skin markings and thickening of the skin within the elbow crease. YES MARC-35.5 Research Exam

Test photograph 12 Dermatitis present in the elbow crease and extending beyond. YES MARC-35.5 Research Exam

Test photograph 13 This is all atopic eczema around this child's ear but this is not a site included in your protocol. NO MARC-35.5 Research Exam

Test photograph 15 Straightforward dermatitis affecting the elbow crease. In fact, the dermatitis is affecting the whole arm, this does not matter as long as the skin crease is involved. YES MARC-35.5 Research Exam

NO Test photograph 16 Normal elbow crease in a child with a dark skin. MARC-35.5 Research Exam

Test photograph 17 Again, look at the last page of your protocol and you will find that any single area greater than 1cm at its minimum diameter counts. I appreciate that it is difficult to be sure of the size of this lesion without a centimetre scale or direct measurement but this patch did in fact satisfy the protocol. YES MARC-35.5 Research Exam

Test photograph 19 This isolated spot in the elbow fold has to be ignored. NO MARC-35.5 Research Exam

Test photograph 24 Even though the dermatitis is straightforward in this slide, the decision to call this visible dermatitis is not so easy as it is not very clear where exactly the elbow crease begins and ends. You can check this by using the subject's palm placed horizontally across the affected crease as specified. Most of this dermatitis would be covered by this child's palm when examined in this way. YES MARC-35.5 Research Exam

Test photograph 27 Erythema is sometimes difficult to appreciate in a black skin but there is definite accompanying surface change here (lichenification). YES MARC-35.5 Research Exam

Test photograph 28 Although atopic eczema affects all of this child's limb, it includes the elbow folds. YES MARC-35.5 Research Exam

Test photograph 29 This child does have a discoid pattern of atopic eczema with some lesions over the shoulder but this is not included in your protocol. (Note elbow flexure). NO MARC-35.5 Research Exam

Test photograph 31 These are again patches of discoid atopic eczema in a child with a dark skin with accompanying surface change but they are not in a designated area. NO MARC-35.5 Research Exam

Test photograph 32 Although there is very little erythema is present in this child with a dark skin, there is marked surface change with crusting and scaling in the elbow crease. YES MARC-35.5 Research Exam

Test photograph 33 Another mild case of atopic eczema. I appreciate that the subtleties of surface change are difficult to appreciate in still photographs such as this. MARC-35.5 Research Exam YES

Test photograph 34 Definite dermatitis with scaling over the fronts of both ankles. YES MARC-35.5 Research Exam

Test photograph 35 There is an area greater than 1cm at its minimum diameter in this child's elbow crease. Very mild atopic eczema like this is typical of the bulk of cases seen in community surveys. YES MARC-35.5 Research Exam

Test photograph 37 There is definite dermatitis present on this child's upper eyelids. YES MARC-35.5 Research Exam

Test photograph 38 There is erythema, pigmentation and lichenification present at the backs of this child's knees. YES MARC-35.5 Research Exam

Test photograph 40 This child has infected atopic eczema behind his knees. Oozing and lichenification is present as well as post inflammatory pigmentation. YES MARC-35.5 Research Exam

Test photograph 41 Dermatitis with lichenification present at the front of the ankle. YES MARC-35.5 Research Exam

Test photograph 43 Normal skin. NO MARC-35.5 Research Exam

NO Test photograph 45 Elbows not a designated area. MARC-35.5 Research Exam

Test photograph 47 Although this is atopic eczema affecting the creases under the buttocks, this is not a designated area in your protocol. NO MARC-35.5 Research Exam

Test photograph 48 YES Here is an easy one for you to finish with. MARC-35.5 Research Exam