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Referral Guidelines

Recommendations for referral to secondary care, from the guidelines for the management of atopic eczema from the Primary Care Dermatology Society and British Association of Dermatologists, dated October 2009:4

  • Refer if the diagnosis is, or has become, uncertain
  • Urgent referral and prompt antiviral treatment if severe infection with herpes simplex (eczema herpeticum) is suspected
  • Refer if the eczema is severe and has not responded to appropriate therapy in primary care, particularly if excessive amounts of potent topical corticosteroids are being prescribed (or moderately potent corticosteroids in children)
  • Refer if the eczema becomes infected with bacteria (manifest as weeping, crusting or the development of pustules) and treatment with an oral antibiotic plus a topical corticosteroid has failed
  • Refer if the eczema is giving rise to severe social of psychological problems; prompts to referral should includes sleeplessness and school absenteeism
  • Refer if management in primary care has not controlled the eczema satisfactorily – failure to improve is probably best based upon a subjective assessment by the child or parent
  • The patient or family might benefit from additional advice on application of treatments (e.g. bandaging techniques)
  • Refer if contact dermatitis is suspected and confirmation requires patch-testing
  • Refer if dietary factors are suspected and dietary control is a possibility (rare)
  • The referral letter should include the reason for referral, what it is hoped will be gained from the referral, and what treatments have been tried so far