'Referral advice' recommendation details
Source guidance details
- Healthcare professionals should refer children with atopic eczema who follow a cow's milk-free diet for longer than 8 weeks for specialist dietary advice.
- Healthcare professionals should exclude secondary bacterial or viral infection if a mild or moderately potent topical corticosteroid has not controlled the atopic eczema within 7-14 days. In children aged 12 months or over, potent topical corticosteroids should then be used for as short a time as possible and in any case for no longer than 14 days. They should not be used on the face or neck. If this treatment does not control the atopic eczema, the diagnosis should be reviewed and the child referred for specialist dermatological advice.
- If eczema herpeticum (widespread herpes simplex virus) is suspected in a child with atopic eczema, treatment with systemic aciclovir should be started immediately and the child should be referred for same-day specialist dermatological advice. If secondary bacterial infection is also suspected, treatment with appropriate systemic antibiotics should also be started.
- If eczema herpeticum involves the skin around the eyes, the child should be treated with systemic aciclovir and should be referred for same-day ophthalmological and dermatological advice.
- Immediate (same-day) referral for specialist dermatological advice is recommended if eczema herpeticum is suspected in children.
- Urgent (within 2 weeks) referral for specialist dermatological advice is recommended for children with atopic eczema if the atopic eczema is severe and has not responded to optimum topical therapy after 1 week or treatment of bacterially infected atopic eczema has failed.
- Referral for specialist dermatological advice is recommended for children with atopic eczema 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 1-2 weeks of flares per month or is reacting adversely to many emollients)
- atopic eczema on the face has not responded to appropriate treatment
- the child or parent/carer may benefit from specialist advice on treatment application (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 giving rise to significant social or psychological problems for the child or parent/carer (for example, sleep disturbance, poor school attendance)
- atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia.
- Children with atopic eczema that has responded to optimum management but for whom the impact of the atopic eczema on quality of life and psychosocial wellbeing has not improved should be referred for psychological advice.
- Children with moderate or severe atopic eczema and suspected food allergy should be referred for specialist investigation and management of the atopic eczema and allergy.
- In children with atopic eczema, diets including soya protein can be offered to children aged 6 months or over with specialist dietary advice.
- Do not use very potent preparations of topical corticosteroids in children without specialist dermatological advice.
- Potent topical corticosteroids should not be used in children aged under 12 months without specialist dermatological supervision.
- Topical calcineurin inhibitors should not be used under occlusion (bandages and dressings) for treating atopic eczema in children without specialist dermatological advice. Whole-body (limbs and trunk) occlusive dressings (including wet wrap therapy) with topical corticosteroids should only be used to treat atopic eczema in children for 7-14 days (or for longer with specialist dermatological advice), but can be continued with emollients alone until the atopic eczema is controlled.
- If eczema herpeticum (widespread herpes simplex virus) is suspected in a child with atopic eczema, treatment with systemic aciclovir should be started immediately and the child should be referred for same-day specialist dermatological advice.
- Healthcare professionals should consider phototherapy or systemic treatments for the treatment of severe atopic eczema in children when other management options have failed or are inappropriate and where there is a significant negative impact on quality of life. Treatment should be undertaken only under specialist dermatological supervision by staff who are experienced in dealing with children.
This page was last updated: 22 August 2012