You should consider referring a patient with contact dermatitis to a dermatologist for further evaluation in several specific situations NICE CKS. Referral is appropriate if the dermatitis, particularly on the hands and face, is severe, chronic, recurrent, or persistent NICE CKS. Additionally, if previously stable dermatitis has become difficult or impossible to control with standard primary care treatments, a referral should be considered NICE CKS.
Referral is also indicated if an allergy to prescribed or over-the-counter topical treatments is suspected NICE CKS. The Primary Care Dermatological Society specifically recommends referral if contact dermatitis may be due to topical treatments like neomycin or corticosteroids NICE CKS. If the suspected contact dermatitis does not respond to primary care treatment, has atypical features, or the diagnosis is unclear, referral is warranted NICE CKS. Furthermore, if the contact dermatitis is thought to be associated with the patient's occupation, a dermatology referral is appropriate NICE CKS.
For children, specialist dermatological advice should be sought if contact allergic dermatitis is suspected, especially if it presents as persistent atopic eczema or affects the face, eyelids, or hands NICE CG57. The British Association of Dermatology also recommends patch testing for chronic or persistent dermatitis, particularly hand and facial dermatitis, and for previously well-controlled atopic/endogenous dermatitis that has become difficult to control, implying a need for specialist evaluation NICE CKS.