When should I consider referring a patient with atopic eczema to a der

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with atopic eczema to a dermatologist if:

the diagnosis is, or has become, uncertain .
management has not controlled the atopic eczema satisfactorily, based on a subjective assessment by the child, parent or carer (for example, the child is having 1 to 2 weeks of flares per month or is having adverse reactions to many emollients) .
atopic eczema on the face has not responded to treatment .
the child or their parents or carers may benefit from specialist advice on how to apply treatments (for example, bandaging techniques) .
contact allergic dermatitis is suspected (for example, persistent atopic eczema or facial, eyelid or hand atopic eczema) .
the atopic eczema is causing significant social or psychological problems for the child or their parents or carers (for example, sleep disturbance or poor school attendance) .
atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia .
if atopic eczema is responding to optimal management but the child's quality of life and psychosocial wellbeing has not improved, refer them for psychological advice .
children with moderate or severe atopic eczema and suspected food allergy should be referred for specialist investigation and management .
children with atopic eczema for growth concerns if they are not growing at the expected trajectory .

When should I consider referring a patient with atopic eczema to a dermatologist?