General Practitioners could consider phototherapy or systemic treatments for the treatment of severe atopic eczema in children when other management options have failed or are inappropriate and where there is a significant negative impact on quality of life.
Systemic therapy should only be considered if all other treatment modalities had been adhered to diligently.
Treatment should be undertaken only under specialist dermatological supervision and by staff who are experienced in dealing with children.
Oral steroids can cause rebound worsening on withdrawal of treatment.
Cyclosporin can be used under close supervision of an experienced clinician although outcomes are variable.
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