Quality standard
Quality statement 5: Referral for specialist dermatological advice
Quality statement 5: Referral for specialist dermatological advice
Quality statement
Children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema are referred for specialist dermatological advice.
Rationale
Specialist dermatological advice may be beneficial for children with atopic eczema to improve the management of their condition. It can help to identify underlying reasons why the atopic eczema is not well controlled (including trigger factors such as contact allergens) or provide support if the condition has a negative impact on quality of life and psychosocial wellbeing. Parents' or carers' assessments of a child's physical or psychosocial wellbeing should be regarded as important determinants of the need for specialist dermatological advice.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements for children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema to be referred for specialist dermatological advice.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from referral pathways.
Process
The proportion of children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema who are referred for specialist dermatological advice.
Numerator – the number of children in the denominator who are referred for specialist dermatological advice.
Denominator – the number of children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers ensure that there are local arrangements for children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema to be referred for specialist dermatological advice.
Healthcare practitioners ensure that children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema are referred for specialist dermatological advice.
Commissioners ensure that they commission services with local arrangements to refer children with uncontrolled or unresponsive atopic eczema, including recurring infections, or psychosocial problems related to the atopic eczema for specialist dermatological advice.
Children with atopic eczema whose eczema does not improve after treatment, becomes infected repeatedly or causes them social or psychological problems are referred to a specialist.
Source guidance
Atopic eczema in under 12s: diagnosis and management. NICE guideline CG57 (2007, updated 2023), recommendations 1.7.1.2 and 1.7.1.3
Definitions of terms used in this quality statement
Specialist dermatological advice
The referral should be to a specialist dermatological unit dealing with paediatric patients, for example a clinician with experience or qualifications in paediatric dermatology. This could include a paediatrician, specialist nurse or a GP with a specialist interest as long as they are within a dermatological unit and trained in paediatric dermatology.
Referral for specialist dermatological advice if the atopic eczema is not well controlled (including as assessed by the child, parent or carer), has not responded to treatment, is associated with recurring infections or if contact allergic dermatitis is suspected. Specialist dermatological advice should also be sought if the physical condition is giving rise to significant social or psychological problems for the child (or their parents or carers), including sleep disturbance or poor school attendance.
Onward referral for psychological advice can be made if necessary. The NICE guideline recommends that 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. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendations 1.7.1.3, 1.7.1.4 and expert opinion]
Equality and diversity considerations
Healthcare practitioners should be aware of the potential difficulties of assessing eczema severity in children with darker skin tones.
Parent or carer assessment should be considered a good indicator of need for referral for all children. This must apply equally to all children regardless of socioeconomic status, and should not depend on the parents' or carers' ability to articulate a need for specialist care.