A patient guide to eczema, psoriasis, and other persistent skin conditions — what to expect from dermatology referrals and how to manage flare-ups effectively.
Many skin conditions can be managed by your GP, but if treatments are not working, if your condition is severe or widespread, or if the diagnosis is unclear, a dermatology referral is appropriate. NHS dermatology waiting times can be long in some areas — if you have private insurance, this is often a good time to use it.
Before your appointment, take clear photos of your skin when it is at its worst (flare-ups may have calmed by the time you see the specialist, so photos are genuinely valuable). Note where on your body you are affected, any patterns you have noticed (seasonal, stress-related, after certain products), and everything you have tried — including emollients, steroid creams, and any over-the-counter or prescription treatments.
List any allergies, your family history of skin conditions, asthma, or hay fever (this cluster is called atopy and is very relevant), and all products you use on your skin, including soaps, detergents, and cosmetics.
Your dermatologist will examine your skin carefully — they may look at areas you had not thought to mention, as skin conditions often affect multiple sites. They might use a dermatoscope (a handheld magnifying device with a light) for a closer look. In some cases, they may take a small skin biopsy under local anaesthetic to confirm the diagnosis.
For eczema (atopic dermatitis), treatment usually follows a stepwise approach: regular emollients as the foundation, topical steroids for flare-ups (your dermatologist will explain the right strength for each body area), and add-on treatments like calcineurin inhibitors (tacrolimus, pimecrolimus) for sensitive areas. For moderate-to-severe eczema, newer treatments like dupilumab and JAK inhibitors are increasingly available on the NHS.
For psoriasis, treatment depends on severity. Mild cases may respond to topical treatments (vitamin D analogues, tar preparations, or topical steroids). Moderate-to-severe psoriasis may need phototherapy (UV light treatment), systemic medications like methotrexate, or biologic injections. Your dermatologist will discuss which options are appropriate for you.
Consistent use of emollients is the single most important thing for both eczema and psoriasis — not just during flare-ups but every day. Your GP can prescribe these on repeat prescription, and you are entitled to generous quantities. Apply them liberally and frequently — at least twice a day, and more if your skin feels dry.
If you are prescribed topical steroids, use them as directed — the "steroid phobia" that puts many people off using them is often based on misunderstandings. Used correctly, they are safe and effective. Your dermatologist or specialist nurse can show you exactly how much to apply (the fingertip unit is a helpful measure).
The National Eczema Society and the Psoriasis Association are excellent UK resources with helplines, information sheets, and community support. If your skin condition is affecting your mental health — which is extremely common and completely understandable — mention this to your dermatologist or GP, as support is available.
Print this list or save it on your phone. It is easy to forget what you wanted to ask once you are in the room.
NuCover can help you find the right consultant — through the NHS, private insurance, or self-pay. Tell us what you are experiencing and we will point you in the right direction.
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