Lack of response to treatment of dermatitis

If dermatitis does not respond to treatment:

• check that the patient is avoiding irritants and allergens (also consider ingredients contained in topical products currently being used for dermatitis treatment)
• check that emollients and topical corticosteroids are being applied correctly (eg right amount, applied to all areas of inflammation and not just the worst)
• check adherence to therapy
• exclude infection—microbiological testing may be needed or may need to be repeated
• exclude allergy to an applied substance and cutaneous drug reaction—refer for patch testing if needed.

If no other explanation for lack of response to treatment is identified, reconsider the diagnosis. Conditions that can be misdiagnosed as dermatitis include perioral dermatitis, rosacea, genital red burning skin syndrome, psoriasis, extramammary Paget disease, lichen planus and lichen sclerosus. Consider dermatologist referral for full assessment.

Also consider dermatologist referral if a more serious diagnosis is suspected, or if there are other red flags for referral (eg patient is systemically unwell).