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.

  • eczema herpeticum
  • erythrodermic dermatitis with systemic symptoms of sepsis or haemodynamically unstable

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-severe (greater than 10% body surface area) endogenous or drug induced eczema
  • allergic and irritant contact dermatitis for further investigation e.g. patch testing
  • severe hand dermatitis
  • type 4 reactions i.e. eczema for consideration of patch testing

Exclusions

  • type 1 symptoms i.e. urticaria, or reactions to foods, refer to Immunology for consideration of prick testing. Dermatology do not provide prick testing

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • moderate-severe eczema
  • moderate-severe allergic and irritant contact dermatitis for further investigation e.g. patch testing
  • severe hand dermatitis

Category 3 (appointment clinically indicated within 365 days)

  • allergic and irritant contact dermatitis for further investigation e.g. patch testing

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.

  • occupation
  • reason for referral
  • duration of symptoms
  • relevant investigations, including pathology and imaging reports
  • past medical history including drug allergies, history of atopy
  • current medications, with start dates
  • provisional diagnosis
  • description of rash or lesion, include size, shape, location, colour and extent at minimum
  • treatment to date
  • any skin biopsy, swab/blood and allergy test results including attachment of pathology

Additional information to assist triage categorisation

  • colour photograph/s of lesion/s
  • radioallergosorbent test (RAST) if performed
  • list of contactants
  • details of impact on quality of life, ability to work/attend school

Clinical management advice

  • regular use of moisturisers and soap free washes
  • treatment of secondary infection
  • control of inflammation with intermittent courses of moderately potent topical corticosteroids

Avoidance of irritants

In addition to avoiding irritants, patients with uncontrolled eczematous eruptions should be advised to avoid allergens that are commonly found in personal care products such as soaps, moisturisers, fragrances and shampoos. This is particularly important for adult patients with new or changing eczematous eruptions. Key things to avoid include:

  • fragrances, which can be found in skin care products and identified by either:
    • ingredients list that includes the words “Fragrance” or “Parfum” (where possible also limonene and linalool)
    • products with a pleasant aroma to them (which can be detected by smelling the product, and due to the addition of various fragrances to the skin care products)
  • certain preservatives that are known to be common allergens, namely Methylisothiazolinone (MI) and Methylchloroisothiazolinone (MCI).

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.