Lloydspharmacy.com Health - Visiting the doctor

Reviewed by Dr Victoria Lewis, specialist registrar in dermatology

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):

when eczema is slow to respond or more severe
when eczema seems to need higher dose steroid creams to control it
if there is a question of contact sensitivity
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:

make the diagnosis of eczema
understand how it affects you
appreciate what you are and have been doing about it
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

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.)
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.)
Are there any aggravating factors? (For example pets or exposure to other possible irritants, including hobby materials.)

Lifestyle points

Does the eczema cause sleep disturbance because of the itching?
What impact does it have on work or school performance?
What are the most important social impacts of the condition?
Does the eczema restrict hobbies or other activities?

Information points

These will often relate to:

Why you have developed eczema (unfortunately not a question that can often be answered in much detail).
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:

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.
The eczema is infected and treatments with oral and topical antibiotics are not working.
The general management of the eczema is problematic, eg because of sleep disturbance or school absenteeism.
The patient or the family might benefit from learning about additional advice on the application of treatments (eg bandaging techniques).
Contact dermatitis is suspected and confirmation requires patch testing.
Dietary factors are suspected and there is a possibility of using dietary control (rare in practice).
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.)
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.}

Based on a text by Dr Dan Rutherford, GP

Last updated 15.09.2005