Dermatology GP Referral Guidelines

Transcription

1 Austin Health Dermatology Department holds 5 Clinic sessions to discuss and plan the treatment of with Dermatology conditions. Department of Health clinical urgency categories for specialist clinics Urgent: Referrals should be categorised as urgent if the patient has a condition that has the potential to deteriorate quickly, with significant consequences for health and quality of life, if not managed promptly. These should be seen within 30 days of referral receipt. For emergency cases please send the patient to the Emergency department. Semi Urgent: Referrals should be categories as Semi Urgent that has the potential to deteriorate within days. Routine: Referrals should be categorised as routine if the patient s condition is unlikely to deteriorate quickly or have significant consequences for the person s health and quality of life if specialist assessment is delayed beyond one month. Exclusions: Cosmetic conditions, Laser Dermatology, Keratosis pilaris GP Triage Acne: Mild to Moderate Moderate to Severe Previous treatment: Oral therapy for at least 12 weeks films & Clinic Urgent: Cystic scarring Acne Mild: 2-3 visits over 6 12 weeks Severe: multiple visits over months Acute ulcers Mouth or Genital If management issues Urgent: Painful lasting more than 4 weeks Clinic

2 GP Triage Allergic contact Dermatitis If management issues Clinic Urgent: If interference with work attendance Cutaneous Lupus requiring systemic therapy Biopsy proven Sun protection Potent topical steroid therapy for 4 weeks films & Clinic Urgent: Acute onset and/or systemically unwell Dermatomyositis When to refer: All with rash and weakness Clinic Urgent: All Dry Skin Daily use of emollients Clinic Routine: All

3 GP Triage Eczema Mild to moderate Moderate to severe requiring systemic therapy Regular emollients and topical cortisone applied twice daily for 4 weeks films & Clinic Urgent: if Erythrodermic or more than 80% coverage. Eczema Herpeticum. Mild: 2-3 visits over 6 12 weeks Severe: multiple visits over months Erythema multiforme, bullous pemphigoid, pemphigus ACTIVE blistering Clinic Urgent: All with active blistering disorders Erythema nodosum or similar lumps on legs Painful lumps for more than 4 weeks. Non responsive to rest and NSAID Clinic Urgent: If lasts more than 6 weeks

4 GP Triage Excess hair growth Sudden onset. Not for cosmetic purposes Clinic Urgent: If sudden onset Excessive sweating Long history > 6 months. No response to topical agents. Clinic Routine: All Haemangioma Adult only Clinic Routine: All Immunosuppressed Urgent: If systemically unwell. Rapidly progressive skin lesions films & Clinic appointment:

5 GP Triage Itch and pruritus Sleep disturbance and failure to respond to treatment Emollients, topical steroids, antihistamines Clinic Routine: All Keloid scars Patient request Clinic Routine: All Melanoma not excised Biopsy proven Urgent: All Excision Clinic appointment Melasma Patient request Clinic Routine: All

6 GP Triage 3 month trial of sun protection and Hydroquinone Nail Problems Culture of nail plate is negative Routine: All Clinic Other auto immune disorders requiring systemic therapy If diagnostic or issue To be included in referral Urgent: Acute onset and/or systemically unwell films & diagnostic results to the Clinic Patchy hair loss or sudden severe hair loss (NOT increased hair shedding) If sudden onset and extensive involvement Clinic Urgent: If rapidly progressive and involves more than one site Photosensitivity Urgent: Sudden onset

7 GP Triage Sun protection Medication reviewed Clinic Pigmentation problems Patient request warn no cosmetic procedures are offered Clinic Routine: All Psoriasis: Mild to Moderate Moderate to Severe Two topical agents applied copiously for 4 weeks each. films & Clinic Urgent: Widespread pustular, erythrodermic or PASI score over 15 Mild: 2-3 visits over 6 12 weeks Severe: multiple visits over months Pyoderma gangrenosum Painful ulcers rapidly increasing in size Clinic Urgent: Patients with active PAINFUL disease

8 GP Triage Rashes widespread, severe, painful If diagnostic or management issues Urgent: All Clinic appointment Rosacea Systemic Tetracycline for 6 weeks Clinic Routine: All SCC, BCC and other tumours growths or lesions Biopsy proven Urgent: To direct Skin Cancer Pathway if appropriate Excision 1 month Clinic appointment Scleroderma On presentation Urgent: If new diagnosis

9 Seborrheic keratoses Suspected scabies Suspicious lesions (onset in last six months) Recently biopsyproven skin cancer (can be removed by simple ellipse) GP If Melanoma cannot be ruled out. Inform that no cosmetic procedures will be offered for Seborrheic keratoses s Lyclear applied appropriately If biopsy has proven skin cancer Following GP and assessment of lesion/s. Clinic Clinic Clinic To be included in referral Diagnostics Biopsy result (current at time of referral) Instruct patient to bring diagnostic results to the Triage Urgent: Suspected Melanoma to Skin Cancer Procedure Clinic Routine: All Urgent: Skin Cancer Pathway if biopsy proven and criteria met Urgent: to General Clinic, If clinically suspicious and biopsy not performed Biopsy Excision Review of biopsy (via telephone) or for ROS (in clinic) Discharge to GP unless: Confirmed Melanoma (referred to General Dermatology or Melanoma Clinic) 1-2 visits depending on results of biopsy, following which patient will be discharged to GP or referred to another Austin Clinic. 1-2 visits depending on results of biopsy, following which patient will be discharged to GP or referred to another Austin Clinic.

10 GP Triage Clinic Risk factors present for further lesions Major complications of procedure (referred to General Dermatology clinic) Tinea (Mild) Failure to respond to Griseofulvin (4 weeks) Clinic Routine: All Tinea (Scalp) If causing hair loss and is clinically suspicious. When culture of scalp scales positive Clinic Urgent: Patients with proven positive culture

11 GP Triage Transplant Patient with suspected skin cancers Diagnosed or suspected skin cancer To be included in referral Urgent: All N/A Instruct patient to bring diagnostic results to the Clinic Vasculitis If diagnostic or management issues Clinic Urgent: If evidence of systemic involvement. Severe extensive skin involvement with ulceration Vitiligo Patient request Clinic Routine: All

12 GP Triage Warts: Present for more than two years, Immunosuppressed Application of 2 different Wart paints nightly for 6 weeks each. To be included in referral Clinic Urgent: Immunosuppressed As required