Guidelines on the Management of Atopic Dermatitis ... - Dermatology

Table 8: Indications for referral for specialist dermatological advice
Immediate (same-day) referral:
If eczema herpeticum (KVE) is suspected*
Urgent referral (seen within two weeks):
If the AE is severe and has not responded to optimal topical therapy after one week
If treatment of bacterially infected AE has failed
Routine (non-urgent) referral: If any of the following apply:
The diagnosis is or has become uncertain.
AE on the face has not responded to appropriate treatment.
The AE is associated with severe and recurrent infections.
Contact allergic dermatitis is suspected.
The AE is giving rise to serious social or psychological problems for the child, parent,
or carer.
The child, parent, or carer might benefit from specialist advice on treatment
application.
Management has not controlled the AE satisfactorily according to a subjective
assessment by the child, parent, or carer.
*KVE=Kaposi‟s varicelliform eruption. KVE refers to viral (HSV/eczema herpeticum,
vaccinia virus / eczema vaccinatum, and Coxsacki virus/eczema coxsackium) infection
superimposed on AE. Eczema herpeticum is the commonest by far.
Patients, parents(s) or caregivers with corticosteroid phobia (CSP) should be referred. CSP
is frequent and is not an irrational fear. CSP is the term to describe all types of fear about
steroid use. In routine clinical practice, it is not unusual for patients to express fear or anxiety
about using topical CS. Topical CSP, a complex phenomenon, may lead to poor adherence
and lack of response.
All patients presenting with erythroderma (dermatitis involving more than 90% of BSA), any
acute flare, spontaneous or precipitated by irritation of the skin, infection, stress and
inadequate itch control need referral.
Complementary / alternative therapies for atopic dermatitis
These treatments can be defined as forms of therapy or examination that have no scientific
basis and for which no effective or diagnostic reliability has been demonstrated by scientific
methods. 1 These modalities are becoming more and more popular, 2 which is understandable
when people are faced with an intractable, incurable, highly symptomatic condition for which
conventional medicine seem to be only partially beneficial. Approximately 30% 3 to 42.5% 1 of
patients with allergies report the use of complementary treatments in Europe; these tend to
be younger women with a higher educational background. 3 No reliable figures or records of
treatment methods exist for the treatment of atopic dermatitis by African traditional healers.