Some young people see GPs or their dermatologist frequently. Aisha remembers being ‘in the doctors like every other week’ for eczema when she was younger which ‘blurred into one massive experience’. Going to the doctors can be time-consuming, especially if you have to travel a long way. It can mean taking time off school, university or work for appointments. Being unable to see a GP soon enough can cause problems, such as when Anissa ran out of her prescribed steroid creams.
If a person gets on well with their doctors or nurses and feels there is progress being made with their skin, frequent appointments can be reassuring. For others, frequent appointments became a repetitive cycle: the same advice, the same treatments, no improvement.
Continually going to the doctors and trying prescribed medicines without any improvement is frustrating. Prescriptions can add up to be very expensive. Some people try to avoid going to the GP unless their eczema is really bad or became infected. Feeling fed up with repetitive doctor appointments made young people keen to be referred to dermatology specialists in the hope that more could be done to help with their eczema.
Some young people saw several different GPs because they’d moved (such as from home to university), couldn’t get an appointment to see the same GP each time or had deliberately switched to a different doctor. This could be very ‘hit or miss’ – sometimes they felt the doctor was better or worse than previous ones. Maham found she had to ‘explain my situation all over again’ each time and would have preferred a consistent GP. Most people who had seen the same GP for years were pleased that the doctor knew them well.
Medical referrals – such as for seeing a dermatologist
Some people felt they received good medical care from their GP (some of whom specialise in skin) and were able to manage their eczema well with this arrangement. Others were keen to see a dermatologist, especially if they had been struggling with eczema for a long time without much improvement. For them, being referred by a GP to see a dermatologist (a medical professional who specialises in skin) was a welcome sign that someone was taking their eczema ‘seriously’. Cat said seeing a dermatologist felt like ‘a big step up’. Not everyone we talked to had seen a dermatologist – sometimes they were happy with seeing GPs or using shop-bought products, other times requests for a referral had been refused by GPs.
The belief that GPs are reluctant to refer to dermatologists was widespread. Some people found that their GPs wanted to keep trying different treatments. Those unhappy with this arrangement sometimes found it could be difficult to persuade their GP otherwise. Aisha said she has been ‘pushy’ but ultimately doctors are in the ‘position of authority’. An exception is Cat who has found it easy to get dermatology referrals – once in her university city and a second time when she moved for work.
There’s often a few weeks wait before a dermatology referral ‘comes through’. George had forgotten about the referral until a reminder letter came in the post. Some people opted to see a dermatologist privately (not on the NHS, so they had to pay for the appointments) to avoid the wait. Jessica saw a private dermatologist out of ‘frustration’ with her vulval eczema.
Some people had seen dermatologists specially trained to treat children with skin conditions (paediatric dermatologists). This was really helpful for Aadam who got help with keratoconjunctivitis (an eczema-related eye condition). The age at which a young patient moves from a paediatric to adult dermatologist varies. For Aadam, this was at age 16. There’s usually a ‘transition’ appointment in paediatric dermatology to check that the young person understands about managing their eczema before they become an adult dermatology patient.
Another kind of referral is for mental health and self-esteem support, as eczema can be difficult to cope with emotionally and psychologically. Most people hadn’t talked much with their doctors about emotional impacts or been offered formal support, such as counselling. Some brought up the topic themselves with their doctors. The reaction from their doctors was not always seen as appropriate though, such as being instantly offered anti-depressants. Support for damaged confidence can also be important even after eczema clears up as there may be visible scars left and low self-esteem may remain.