Allergy care pathway for eczema

Eczema is a persistent inflammatory itchy skin condition. This is one of several allergy care pathways, which tell health professionals what they need to know in order to provide the best care possible.


The College's care pathway for eczema is presented in two parts:

  • an algorithm with the stages of ideal care, and
  • a set of competences required to diagnose, treat and optimally manage eczema.

The algorithm has numbers which correspond to the competences outlined within the body of the document.

We recommend that this pathway is implemented locally by a multidisciplinary team with a focus on creating networks between staff in primary and community healthcare, social care, education and hospital-based practice to improve services for children with allergic conditions. All specialists should have paediatric training.

Download the full RCPCH Care Pathway for Children with Eczema below.


Atopic eczema (atopic dermatitis) is a persistent inflammatory itchy skin condition that develops in early childhood in the majority of cases. It is typically an episodic disease of exacerbation (flares, which may occur as frequently as two or three per month) and remissions, except for severe cases where it may be continuous.

Diagnostic criteria for eczema are well defined. Atopic eczema should be diagnosed when a child has an itchy skin condition plus three or more of the following:

  • visible flexural dermatitis involving the skin creases, such as the bends of the elbows
  • personal history of flexural dermatitis (or dermatitis on the cheeks and/or extensor areas in children aged 18 months or under)
  • personal history of dry skin in the last 12 months
  • personal history of asthma or allergic rhinitis (or history of atopic disease in a first degree relative of children aged under four years)
  • onset of signs and symptoms under the age of two years (this criterion should not be used in children aged under four years).

Healthcare professionals should also be aware that in Asian, Black Caribbean and Black African children, atopic eczema may present differently; it can cause skin darkening as opposed to skin reddening (erythema) and can affect the extensor surfaces rather than the flexures. Discoid (circular) or follicular (around hair follicles) patterns of eczema may be more common.