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Reviewed by Dr Victoria Lewis, specialist registrar in dermatology
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Skin conditions are common – an estimated 15 per cent of the
population consult their GP for this reason each year. And
eczema is the most common category of
skin problem that GPs see.
By dint of experience, a GP often builds up preferred ways of
treating eczema, for example in the selection of
moisturisers and
steroid creams.
In the UK, eczema is largely dealt with by GPs. However, GPs may
need to seek the help of a consultant skin specialist (dermatologist):
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when eczema is slow to respond or more severe
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when eczema seems to need higher dose steroid creams to control
it
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if there is a question of contact sensitivity
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if there are other issues about the nature of the
treatment.
Eczema and the GP
The average time for an ordinary appointment is only eight
minutes, and it is impossible to cover all the points about a long-term
condition such as eczema in such a short time.
In the UK, you have the advantage of being able to see the same
doctor repeatedly, and several short appointments can be as good as, or even
more helpful, than one or two long ones. Usually, it’s also possible to book a
double appointment with your GP if you know you’ve a few things to discuss.
Although there are guidelines for treatment, a large element of
‘try it and see’ is involved in finding the best sorts of emollients,
anti-inflammatory creams or other routines to use for an individual’s eczema.
Depending on how the patient responds to treatments, it can take
several appointments and some weeks or months to get the right treatment
balance if someone has active eczema.
Useful information for the consultation
It can be helpful to your doctor if you note down a few points
in advance (see below). Your answers will help your GP to:
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make the diagnosis of eczema
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understand how it affects you
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appreciate what you are and have been doing about it
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put together a treatment plan for you.
Altogether this is a lot of information and will probably need
to be discussed over several appointments.
Diagnostic points
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Is there a family history of eczema, or of other allergic
conditions such as hay fever and asthma? (Eczema is more likely when there is a
positive family history.)
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When did the condition first appear? (Usually this is in
childhood for
atopic eczema, but not always.
Occupational eczema may relate to a change of job or of routines at
work.)
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Are there any aggravating factors? (For example pets or
exposure to other possible irritants, including hobby materials.)
Lifestyle points
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Does the eczema cause sleep disturbance because of the
itching?
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What impact does it have on work or school
performance?
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What are the most important social impacts of the
condition?
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Does the eczema restrict hobbies or other activities?
Information points
These will often relate to:
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Why you have developed eczema (unfortunately not a question
that can often be answered in much detail).
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What you can do to treat your eczema.
Treatment points
Topical treatments
If you've had eczema for a while, you may have tried a
range of different
moisturisers and
steroid creams of different
strengths. This information should be in your medical notes, but that doesn’t
always mean that it's easy to find! So it’s a good idea to take all your
current treatments with you to the surgery. Your doctor can then see at a
glance what you’re using, how old the tubes are and so on. This is important
because all medicines have an expiry date, and after this time they lose their
potency.
Dietary treatments
Exclusion diets are when a range of foods are at first
avoided and then re-introduced to see which foodstuffs seem to trigger the
eczema. These diets rarely prove helpful to people with eczema, and they need
to be conducted with care on children to ensure their nutritional needs are
met.
Nonetheless, a small proportion of people seem to benefit
from them. Any previous experience you have of such dietary treatment, or
knowledge of foodstuffs that may trigger your eczema, can be very valuable.
Complementary therapies
Many different types have been tried in the treatment of
eczema. There are some trials suggesting that Chinese herbal medicine (a
standard treatment in China) can be effective. Information also suggests that
some of these herbal treatments may be doped with steroids or carry significant
side effects, but this does not rule them all out as an option.
Whatever other treatments you wish to use for your eczema,
it is far better for your doctor to know what you are trying. There could be
important interactions between the treatments that need to be
considered.
Referral to a dermatologist
Although eczema is common, it is not always easy to treat.
Specialists in skin disease (dermatologists) are relatively few in the UK
compared with most other countries; waiting lists for NHS skin clinics are
long. Not everyone with eczema needs to see a specialist, but there are
guidelines to indicate which patients would benefit from referral - you can
discuss this with your GP.
The general reasons for referring* an eczema patient to a
consultant include:
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The eczema is severe and is not responding to the usual
treatments a GP has available. This is especially so if many potent steroid
creams are being used.
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The eczema is infected and treatments with oral and topical
antibiotics are not working.
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The general management of the eczema is problematic, eg because
of sleep disturbance or school absenteeism.
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The patient or the family might benefit from learning about
additional advice on the application of treatments (eg bandaging techniques).
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Contact dermatitis is suspected and
confirmation requires
patch testing.
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Dietary factors are suspected and there is a possibility of
using dietary control (rare in practice).
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If eczema becomes infected with herpes simplex virus. (This is
the virus that causes cold sores and can occasionally spread to cause the
condition called eczema herpeticum, which needs prompt treatment with antiviral
drugs.)
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For prescribing the
new anti-inflammatory drugs such as
tacrolimus and pimecrolimus. Although the latter is licensed for GP use, many
will still prefer to go with the recommendations of the dermatologist before
issuing a prescription.
*Adapted from the referral guidelines of the Primary
Care Dermatology Society.
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Based on a text by Dr Dan Rutherford, GP
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Last updated 15.09.2005
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