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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Inclusions

  • nodular/cystic acne or moderate-severe scarring acne
  • acne wherein appropriate skin care measures, including a trial of prescription topical treatments AND oral antibiotics have not been effective
  • patients for whom the acne is having a significant impact on mental health, or causing discomfort
  • patients who have early scarring despite the severity of their acne

Exclusions

  • patients older than 17.5 years of age
  • mild acne responding to topicals, or for patient who have not yet tried first-line therapies, without scarring

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • severe acne
  • acne with scarring
  • acne fulminans. These referrals will be seen urgently and should be discussed with the relevant Local Health Network at time of referral

Category 2 (appointment clinically indicated within 90 days)

  • moderate acne not responding to first line therapies

Category 3 (appointment clinically indicated within 365 days)

  • nil

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.

  • history of acne, associated symptoms
  • impact of acne on mental health
  • prescription treatment to date, include specific names of treatments, doses, duration and response to treatment
  • other medical conditions
  • medication history and contraception history if relevant
  • recent blood tests and any other relevant previous investigations
  • copies of other relevant letters

Additional information to assist triage categorisation

  • family history

Clinical management advice

Please note the Women’s and Children’s Hospital (WCH) Acne Pilot clinic is run via Telehealth. Referrals are accepted from the WCH catchment area and regional South Australia; if a public dermatology service exists closer to home for your patient, please refer the patient to that service.

Recommended management whilst awaiting Dermatology appointment

  • implement general skin care measures including soap and fragrance-free wash twice daily, a light non-comedogenic moisturiser, light sunscreen (SPF 50+)
  • commence topical treatment as appropriate e.g. topical benzoyl peroxide, topical adapalene or tretinoin, combination product (e.g. benzoyl peroxide/adapalene - Epiduo Gel, clindamycin/adapalene - Acnatac, benzoyl peroxide/clindamycin - Duac)
  • consider oral antibiotics (e.g. doxycycline 50mg-100mg or minocycline 50-100mg daily for patients > 8 years of age) in combination with topical treatment for patients with moderate acne or acne unresponsive to topical treatment alone
  • consider combined oral contraceptives (especially anti-androgenic option such as Diane-35, Yaz or Yasmin) for females with acne who are also wishing to commence contraception, or who have menstrual issues
  • for teenage girls, especially if there are signs of hyperandrogenism (i.e. thinning hair, irregular periods, hirsutism) consider the use of oral anti-androgens from 25-200mg daily, alongside contraception
  • other general measures including a low-glycaemic index diet and minimising skim milk and the use of whey protein powders, have been shows to be of assistance in minimising acne

Recommendations when using topical acne treatments

  • start topical treatments slowly. Apply to affected areas two nights per week, increasing to nightly as tolerated, washing off in the morning. Or, begin initially with short contact application, such as for one hour only, building up over time. If skin becomes too irritated, reduce frequency of application.
  • apply to completely dry skin (applying to wet skin increases the risk of irritation)
  • apply a moisturising lotion (e.g. Cetaphil lotion, Cerave lotion, QV lotion) 30 minutes after application of the prescription topical product
  • daily application of non-greasy sunscreen as prescription topical and oral treatments may cause increased sun sensitivity

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.