Secondary care options: phototherapy and oral immunosuppressants

Patients with moderate to severe eczema who are unresponsive to topical therapies in primary care should be referred to secondary care. Phototherapy and other systemic treatments in children should only be initiated after assessment and documentation of disease severity and assessment of quality of life (NICE, 2007). The Primary Care Dermatology Society and the British Association of Dermatologists (PCDS and BAD) have developed referral guidelines for all patients with atopic eczema which are outlined in Box 9.3 (Primary Care Dermatology Society and British Association of Dermatologists, 2006).

Box 9.3 PCDS–BAD (2006) –Referral guidelines for atopic eczema Diagnostic doubt Severe eczema Failure to respond to appropriate therapy in primary care Eczema not satisfactorily controlled in primary care Severe infected eczema Bacterial infection Eczema herpeticum Specialist opinion for counselling patients and families with severe social or psychological problems related to eczema. Additional advice on treatment application. Patch testing for suspected contact dermatitis. Consideration for dietary manipulation.

Patients with severe eczema should be referred to secondary care for phototherapy and systemic therapies.