Consultant dermatology · UK
Eczema treatment, from emollients to biologics.
A patient guide to the modern British Association of Dermatologists and NICE pathway for atopic eczema — the topical steroid ladder, calcineurin inhibitors, phototherapy, conventional systemics, and the NICE-approved biologics and JAK inhibitors when the plan needs to go further.
Why patients choose us
- 01
A consultant dermatologist, not a GP-plus-cream
A named consultant dermatologist and a specialist eczema nurse — the pair who actually run the modern BAD pathway from emollients to biologics.
- 02
Patch testing and allergy work-up in-house
Contact dermatitis mimics atopic eczema. We arrange proper patch testing, and skin-prick or specific IgE testing where infantile eczema looks food-driven.
- 03
The NICE biologic pathway, when you need it
If topicals, phototherapy and conventional systemics have not held it, we escalate to dupilumab, tralokinumab or a JAK inhibitor through the proper NICE TA route.
Indicative pricing
What private eczema treatment costs in the UK.
Indicative ranges for the dermatology appointment, testing, phototherapy course and biologic self-pay. We confirm firm figures once we know your case.
In short
A consultant dermatology appointment: £250–£450, plan the same visit.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant dermatology consultation | £250–£450 | 30–45 min | Same visit |
| Follow-up appointment | £180–£300 | 20 min | Same visit |
| Patch testing (contact dermatitis) | £450–£900 | 3 visits over 1 week | Day 5–7 |
| Skin-prick testing (allergy) | £250–£500 | 30–45 min | Same visit |
| Narrowband UVB phototherapy (course) | £1,200–£2,800 | 20–30 sessions | Over 8–12 weeks |
| Dupilumab (Dupixent) — self-pay | £1,100–£1,400 per month | Fortnightly injection | Ongoing |
Prices vary by hospital, by the consultant, by whether tests are needed, and by drug pricing. Insurers usually fund dermatology assessment, phototherapy and NICE-approved biologics where criteria are met — we confirm cover before booking.
The problem
Emollient. Steroid. Emollient. Steroid. And nothing changes.
Most adults with moderate-severe eczema have been round the same loop for years. The modern pathway is different — patch testing where relevant, calcineurin inhibitors, phototherapy, and a NICE route into biologics and JAK inhibitors when needed.
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Sceptical about steroids?
Used properly, matched to potency and body site, with a step-down plan — safe and effective. Left unused, uncontrolled eczema does more harm.
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Flare, treat, flare, treat?
Proactive maintenance with a TCI or lower-potency steroid two days a week is the standard-of-care fix — not endless rescue courses.
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Ready for a biologic?
If a conventional systemic has failed or is unsuitable, we build the NICE case for dupilumab, tralokinumab or a JAK inhibitor.
The journey
From severity score to tailored plan — and escalation, if it needs it.
One dermatologist and one specialist nurse from first message to review — including the escalation to biologic or JAK therapy if the plan does not hold.
Phase 1 · Before your appointment
Concierge, off-stage for you
Phase 2 · At the clinic
A dermatology visit that ends with a plan
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. How long, where on the body, what makes it flare, what you have already tried.
- 02
Before
Severity and quality-of-life scored
The dermatologist scores severity (POEM, EASI) and impact (DLQI or CDLQI in children) — the same tools NICE uses to gate biologic therapy.
- 03
Before
A tailored plan comes back
Within one working day: the right emollient, the right topical steroid strength for each body site, a written flare plan, and any tests we would add.
- 04
At the clinic
The dermatology appointment
Skin examination, patch testing set up if contact dermatitis is suspected, and a live demonstration of finger-tip units and wet-wrap technique.
- 05
At the clinic
Escalation, if the plan is not enough
Narrowband UVB phototherapy for widespread disease, or a conventional systemic — methotrexate, ciclosporin, azathioprine or mycophenolate — under monitoring.
- 06
After
Biologic or JAK inhibitor pathway
If conventional systemics fail or are unsuitable, we build the NICE TA case for dupilumab, tralokinumab, lebrikizumab, abrocitinib or upadacitinib.
- 07
After
Long-term review, in your inbox
A written plan, review at 8–12 weeks, and a single named clinician who stays with your case rather than a new face each visit.
Typical end-to-end: 2 weeks to first appointment. Meaningful response on a new plan: 8–12 weeks.
When it helps
When a proper dermatology plan changes the picture.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Widespread atopic eczema
Eczema affecting more than a small area — often needs phototherapy or systemic therapy rather than tubes of steroid alone.
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Facial or eyelid eczema
Sensitive skin sites where potent steroids are unsafe long term — where topical calcineurin inhibitors earn their place.
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Steroid ladder not holding
Flares returning as soon as steroid stops — the point at which maintenance TCIs, phototherapy or a biologic get considered.
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Suspected contact dermatitis
Eczema in an unusual pattern — hands, face, behind the ears — that may be driven by an allergen and needs patch testing.
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Recurrent infected eczema
Weeping, crusting flares needing repeated antibiotics — a marker that the underlying disease is not controlled.
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Sleep, work or school being wrecked
A high DLQI or CDLQI score is not a soft outcome — it is the score that unlocks the NICE biologic pathway.
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Infantile eczema, food-driven
Where an infant’s eczema flares reproducibly with a food, we arrange allergy testing and a paediatric dermatology opinion.
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Red flag: eczema herpeticum
Sudden painful, punched-out blisters on eczematous skin, often with fever — a dermatological emergency, A&E the same day.
Treatment options
The full modern eczema ladder — in order.
What each rung on the ladder actually involves, from twice-daily emollient to biologics and JAK inhibitors.
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Basic care — for everyone, forever
Emollient at least twice daily, soap substitute in place of shower gel and shampoo, and honest trigger review (soap, hard water, wool, sweat).
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Topical steroid ladder
Mild (hydrocortisone 1%) for face and folds, moderate (Eumovate) for body flares, potent (Betnovate) for stubborn plaques, very potent (Dermovate) sparingly and never on the face — dosed in finger-tip units.
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Topical calcineurin inhibitors
Tacrolimus (Protopic) and pimecrolimus (Elidel) — steroid-sparing, safe for face, eyelids and flexures, and useful for weekend maintenance to prevent flares.
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Wet wraps for flares
A layer of emollient and topical steroid under damp tubular bandages — a paediatric mainstay for a bad flare in a child.
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Narrowband UVB phototherapy
Three visits a week for 8–12 weeks in a dermatology unit — a well-evidenced option for widespread eczema that has outgrown creams.
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Conventional systemics
Methotrexate, ciclosporin, azathioprine or mycophenolate mofetil under blood-test monitoring. Oral steroids are used only for very short rescue courses — not as maintenance.
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Biologics — dupilumab, tralokinumab, lebrikizumab
Injectable IL-4/IL-13 (dupilumab, licensed from 6 months) or IL-13 (tralokinumab, lebrikizumab) — NICE-approved for moderate-severe eczema when conventional systemics have failed or are unsuitable.
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JAK inhibitors — abrocitinib, upadacitinib
Oral Cibinqo (abrocitinib) and Rinvoq (upadacitinib) — fast, powerful, and NICE-approved via TA route. VTE, MACE and malignancy warnings mean we screen carefully and monitor closely.
Our vetted UK network
A small panel of dermatologists, we picked them.
Consultant dermatologists across London and the major UK cities — not listed publicly; introductions are made privately, once we understand your case.
Selection criteria
How we choose every dermatologist in our network.
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Consultant dermatologists, not GPs with a special interest
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A specialist eczema nurse for finger-tip-unit and wet-wrap teaching
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In-house patch testing to the British Society for Cutaneous Allergy standard series
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Access to phototherapy, conventional systemics and the NICE-approved biologic and JAK pathway
Safety and red flags
The risks worth naming, honestly.
Every rung on the eczema ladder has trade-offs. Modern practice keeps them small — and knows when to escalate rather than push the same lever harder.
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Topical steroid atrophy is real, but avoidable
Long-term potent steroid on the same site thins the skin and causes striae. The finger-tip-unit rule and step-down to TCIs are how we prevent it.
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Periorbital steroid needs care
Repeated potent steroid around the eyes has been linked with glaucoma and cataract. This is exactly where tacrolimus ointment earns its keep.
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Topical steroid withdrawal (TSW)
A contested but real-world issue after long high-potency steroid use. We take patient reports seriously, and taper thoughtfully with TCIs and non-steroid strategies.
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Growth in children on frequent potent steroid
Rare but described. In a child needing potent steroid week after week, that is the trigger to escalate — not to increase the steroid.
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Eczema herpeticum — emergency
Painful, monomorphic, punched-out blisters on eczema skin, often with fever, is a dermatological emergency. Same-day A&E and IV aciclovir — not a creams review.
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Secondary bacterial infection
Golden crusting, weeping, sudden worsening — usually Staphylococcus aureus, occasionally MRSA. Swab, oral antibiotic if indicated, and bleach baths for recurrent cases.
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Erythroderma
Eczema covering more than 90% of the body surface is erythroderma — a medical emergency needing admission for fluid, temperature and infection management.
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Biologic-associated conjunctivitis
Dupilumab causes conjunctivitis in a meaningful minority. It is usually manageable with lubricants or topical steroid drops under ophthalmology guidance, not a reason to abandon the biologic.
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JAK inhibitor cardiovascular and clot risk
MHRA and NICE flag VTE, MACE, serious infection and malignancy warnings for JAK inhibitors, particularly over 65 or with cardiovascular risk. Screening and shared decision-making are non-negotiable.
Reading your eczema plan
Your written plan in four parts. Read the last one first.
Whichever step of the ladder you are on, the plan the dermatologist writes for you keeps to the same shape.
A quiet reminder
Dermatology language is precise — “moderate potency, twice daily, one FTU per hand” — and we translate it for you.
If you would like us to talk you through the plan before your review, just ask.
- 01 Header
Diagnosis, distribution, severity
Atopic eczema versus discoid, seborrhoeic or contact dermatitis; where on the body; POEM and EASI scores; DLQI or CDLQI for impact.
- 02 Plan
The written flare plan
Which emollient, which soap substitute, which topical steroid at which strength for which body site, and how many finger-tip units per application.
- 03 Maintenance
Weekend or twice-weekly maintenance
Where a topical calcineurin inhibitor or a lower-potency steroid is used two days a week to prevent the next flare — a proactive strategy that works.
- 04 Escalation
When we escalate, and to what
Read this first: the triggers to move to phototherapy, to a conventional systemic, and — if needed — to the NICE-approved biologic or JAK pathway.
Recognised by major UK insurers
Cover for dermatology, phototherapy and NICE-approved biologics varies by insurer and by policy — we confirm cover before booking.
Frequently asked
Everything we get asked about eczema treatment.
Straight answers on steroids, tacrolimus, dupilumab, JAK inhibitors and when to worry.
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Are topical steroids safe for eczema?
Yes, when used correctly. The finger-tip-unit rule, matching potency to body site, and stepping down to topical calcineurin inhibitors or emollient-only once the flare settles keeps them safe. Uncontrolled eczema is more harmful than appropriate topical steroid use.
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What is the difference between Protopic, Elidel and steroid cream?
Tacrolimus (Protopic) and pimecrolimus (Elidel) are topical calcineurin inhibitors — they calm eczema without thinning the skin, which makes them well suited to the face, eyelids and skin folds and to long-term maintenance.
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When is dupilumab (Dupixent) the right step?
NICE TA534 recommends dupilumab for moderate-to-severe atopic eczema in adults, and later TAs extend it down to children aged six months and above, when at least one conventional systemic (ciclosporin, methotrexate, azathioprine or mycophenolate) has failed, is contraindicated or is not tolerated.
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Are JAK inhibitors safer than biologics?
Not necessarily. Abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are powerful and fast-acting, but the MHRA class warnings on venous thromboembolism, major cardiovascular events, serious infection and malignancy mean we screen and monitor them carefully — especially over 65 or with cardiovascular risk factors.
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What is topical steroid withdrawal (TSW)?
A pattern of burning, redness and rebound flaring reported after long, high-potency topical steroid use — most commonly on the face. It is debated in the mainstream literature but taken seriously by dermatologists; a slow taper, generous emollient and TCIs are the usual approach.
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Is my eczema being caused by a food?
In infants with severe eczema an occasional food does drive flares, and skin-prick or specific IgE testing plus a supervised dietary trial is reasonable. In older children and adults, food is a much less common driver — cutting foods out on suspicion often does more harm than good.
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How much does dupilumab cost privately in the UK?
Self-pay costs are typically £1,100–£1,400 per month for the fortnightly injection, plus the dermatology follow-up. Many insurers cover it when the NICE criteria are met and a consultant has documented failure of a conventional systemic.
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When should I go to A&E rather than book an appointment?
Painful, punched-out blisters on eczematous skin (eczema herpeticum), fever with rapidly spreading redness, or eczema covering nearly the whole body (erythroderma) are dermatological emergencies. Same-day A&E, not a clinic booking.
Related
Looking for something else?
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Eczema (condition guide)
The condition itself — causes, types and diagnosis.
Learn more -
Patch test for contact allergies
Standard series patch testing for suspected contact dermatitis.
Learn more -
Skin-prick tests
Allergy testing where infantile eczema looks food-driven.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more
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