Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • in the event of an acute abscess flare, please contact the dermatology team in business hours rather than sending directly to the emergency department.

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

  • Lyell McEwin Hospital (08) 8182 9000, during business hours. After 5:00 pm contact either of the CALHN services. 

Southern Adelaide Local Health Network

Inclusions

  • moderate to severe disease (Hurley stage 2 to 3) with pain and/or significantly affecting quality of life
  • moderate to severe disease (Hurley stage 2 to 3) not responding to standard treatment, therefore requiring consideration of systemic or physical therapies (intra lesional steroid injections, deroofing surgery)
  • diagnostic challenge

Exclusions

  • mild HS managed with topical and episodic use of oral antibiotics

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • moderate to severe HS that does not respond to topicals and/or episodic use of oral antibiotics causing pain/impairment of activities of daily living (ADLs)
  • diagnostic challenge

Category 3 (appointment clinically indicated within 365 days)

  • moderate to severe HS that does not respond to topicals and/or episodic use of oral antibiotics

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • this condition is not primarily infective and wound swabs are not necessary.
  • metabolic syndrome is a common association necessitating screening. Obesity, hypertension, dyslipidaemia, impaired insulin tolerance.

Additional information to assist triage categorisation

  • detailed description of prior treatments, including agent, dose, duration of treatment. This is essential for Pharmaceutical Benefits Scheme (PBS) application for biologic medications for HS)

Clinical management advice

  • HS consists of recurrent inflammatory nodules and abscesses typically in the axillary, inframammary, and inguinal regions. It can also affect buttocks, genital areas, and occasionally be extensive. These lesions are painful and heal by scarring and sinus formation with recurrent malodorous discharge. Early referral is integral in preventing these changes which can have significant long-term psychosocial impact.
  • oral antibiotics for 3 to 6 months may be tried, e.g. doxycycline or minocycline
  • anti-androgen therapy may be of benefit in some females.
  • the general practitioner is integral in the long-term surveillance and management of metabolic syndrome
  • lifestyle modification: Smoking and raised body mass index (due to increased skin friction) are identified as significant risk factors in the development of HS. Addressing these factors may reduce disease activity. Skin friction can also be caused by tight clothing and shaving. in some patients with increased hair in the area of involvement, laser hair removal may be appropriate.
  • antimicrobial washes: Use PhysoHex wash (Triclosan 1%) or Microshield wash (Chlorhexidine 2%) twice weekly in the shower to involved areas
  • antimicrobial agents: The use of Clindatech lotion (Clindamycin 1%) dabbed onto active lesions twice daily can reduce the length of a flare. Longer courses (2-3 months) of Doxycycline (50-100mg/day)/Minocycline (50-100mg/day) can be given during an acute flare.
  • hormonal medications: The anti-androgenic oral contraceptive pills (Yaz, Yasmin, Dianne-35) can often be helpful for women with HS especially if they experience a peri-menstrual flare. Low dose Spironolactone (i.e. 25-100mg daily) can also be helpful.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.