It is not unusual for patients with scabies to be mistakenly referred with ‘eczema’. Therefore it is well worth checking the hands, feet and genitalia for burrows.

Primary care

Patients can be treated initially with first line therapies:

	Mild topical steroid on the face			Consider a sedating antihistamine for itching at night
	Mild or moderate topical steroid on the trunk			Antibiotics are used for patients with suspected secondary bacterial infection and oral aciclovir for suspected herpes simplex infection.
	Topical emollient – liberally and regularly applied
	Bath emollient

• Please do not commence on oral steroids. This may be dangerous in erythrodermic eczema, generalised eczema and eczema herpeticum, and always makes subsequent management of eczema more difficult.
• Patients with severe atopic eczema that is likely to require second line therapy should be referred and commenced on a first line treatment whilst awaiting their appointment.

Specialist services

These are in a position to:

• confirm or establish the diagnosis
• provide in-patient care
• optimise treatment regimens
• explain and advise parents and patients on treatments that are available and demonstrate how they should be used; offer the family and patient support and counselling as necessary
• provide and support specialist nursing services working in primary and secondary care
• provide and supervise treatment in those with severe disease who may require phototherapy (UVB, PUVA) or immunosuppressive therapy
• patch-test those with suspected superimposed contact allergic dermatitis (in practice this test is rarely required)
• provide dietary assessment and supervision of an elimination diet on the rare occasions these are needed.

 

Referral Advice

Most patients with acne can be managed in primary care. They should, however, be referred to a specialist service if they:

	Infection with disseminated herpes simplex (eczema herpeticum) is suspected
	Patient has erythrodermic eczema
	The disease is severe and has not responded to appropriate therapy in primary care
	The eczema becomes infected with bacteria (manifest as weeping, crusting, or the development of pustules), and treatment with an oral antibiotic plus a topical corticosteroid has failed
	The eczema is giving rise to severe social or psychological problems
	Treatment requires the use of excessive amounts of potent topical corticosteroids
	Management in primary care has not controlled the eczema satisfactorily. Ultimately, failure to improve is probably best based upon a subjective assessment by the patient or if a child, their parent
	The patient or family might benefit from additional advice on application of treatments (bandaging techniques)
	contact dermatitis is suspected and confirmation requires patch-testing (this is rarely needed)
	The patient has uncontrolled eczema and dietary factors are suspected (refer directly to a dietician)

 

Immediate

Urgent

Soon

Routine

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