When should I refer a patient with contact dermatitis to a dermatologist for further evaluation?

You should consider referring a patient with contact dermatitis to a dermatologist for further evaluation in several specific situations ¹. Referral is appropriate if the dermatitis, particularly on the hands and face, is severe, chronic, recurrent, or persistent ¹. Additionally, if previously stable dermatitis has become difficult or impossible to control with standard primary care treatments, a referral should be considered ¹.

Referral is also indicated if an allergy to prescribed or over-the-counter topical treatments is suspected ¹. The Primary Care Dermatological Society specifically recommends referral if contact dermatitis may be due to topical treatments like neomycin or corticosteroids ¹. If the suspected contact dermatitis does not respond to primary care treatment, has atypical features, or the diagnosis is unclear, referral is warranted ¹. Furthermore, if the contact dermatitis is thought to be associated with the patient's occupation, a dermatology referral is appropriate ¹.

For children, specialist dermatological advice should be sought if contact allergic dermatitis is suspected, especially if it presents as persistent atopic eczema or affects the face, eyelids, or hands ². The British Association of Dermatology also recommends patch testing for chronic or persistent dermatitis, particularly hand and facial dermatitis, and for previously well-controlled atopic/endogenous dermatitis that has become difficult to control, implying a need for specialist evaluation ¹.