When should I consider referring a patient with severe dermatitis to a dermatologist?

For severe dermatitis, consider referring a patient to a dermatologist in several situations.

• Atopic Eczema (in children under 12):
• Immediately refer if eczema herpeticum is suspected ¹.
• Urgently (within 2 weeks) refer if severe atopic eczema has not responded to optimal topical therapy after one week, or if treatment of bacterially infected atopic eczema has failed ¹.
• Consider referral if the diagnosis is uncertain, or if management has not satisfactorily controlled the atopic eczema, such as the child experiencing one to two weeks of flares per month or having adverse reactions to many emollients ¹.
• Refer if atopic eczema on the face has not responded to treatment ¹.
• Refer if the atopic eczema is causing significant social or psychological problems for the child or their parents or carers, including sleep disturbance or poor school attendance ¹.
• Refer if atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia ¹.
• Contact Dermatitis:
• Consider referral if the dermatitis, particularly on the hands and face, is severe, chronic, recurrent, or persistent ².
• Refer if previously stable dermatitis has become difficult or impossible to control with standard treatments ².
• Refer if allergy to prescribed or over-the-counter topical treatments is suspected ².
• Refer if suspected contact dermatitis does not respond to treatment in primary care, has atypical features, or the diagnosis is unclear ².
• Consider referral if contact dermatitis is thought to be associated with occupation ².
• Seborrhoeic Dermatitis (in infants and children):
• Refer infants and children with severe, extensive, or recalcitrant seborrhoeic dermatitis ³.
• Referral is necessary to identify a possible serious underlying cause, as extensive or severe disease may be associated with immune deficiency ³.
• Children with widespread or recalcitrant disease should be referred to dermatology ³.