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Eczema (Dermatitis), Atopic (Adult)

Atopic eczema is a common relapsing and remitting skin disease. While some individuals seem to ‘grow out’ of their eczema during childhood, or experience long periods of remission, a significant proportion of patients will have ongoing chronic disease in adulthood which can flare particularly at times of stress. Regular treatment is required.

In secondary care we offer phototherapy and a range of immunosuppressant drugs to manage moderate to severe disease, as well as investigations such as patch testing and photo testing. New targeted biologic drugs are also becoming available. While most patients can be managed in general dermatology clinics, the patients with the most severe disease will be managed in the dedicated adult eczema clinic.

R.C 24-05-24

Dermatology Referral Criteria

Routine or urgent general dermatology SCI Gateway referral depending on severity:

  • Diagnostic doubt
  • Failure to respond to continuing use of appropriate topical moderately potent treatment.  Please see ‘suggested topical treatment regimes’ in the Primary Care Management tab for more information
  • Sleep problems and psychosocial upset
  • Recurrent secondary infection
  • Persistent facial or flexural disease which may respond to a topical calcineurin inhibitor
  • History suggestive of contact allergy
  • Facial eczema, particularly peri-ocular eczema
  • Hand eczema, particularly if affected by or affecting occupation
  • Patient requesting oral steroids to manage their eczema. Oral steroids can cause a rebound flare when they are stopped and make atopic eczema more unstable and difficult to manage

Emergency referral (contact on-call dermatology registrar via NHS Lothian Switchboard)

  • Suspected eczema herpeticum
    • see Primary Care Management tab for more information
  • Erythrodermic eczema (>90% coverage +/- systemically unwell)