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.

  • suspected eczema herpeticum – widespread, discrete small areas involving the eyes or associated with fever
  • severely infected eczema
  • eczema involving > 80% of body surface area (erythroderma)

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

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

  • moderate to severe eczema not responding to first line therapies
  • moderate to severe eczema in specific patterns of involvement: eyelid/facial/hand dermatitis

Exclusions

  • mild eczema responding to first line therapies
  • mild eczema where first line therapies have not yet been trialled

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • moderate to severe eczema in an infant (less than 12 months of age)

Category 2 (appointment clinically indicated within 90 days)

  • moderate to severe eczema in a child or adolescent not responding to first line therapies

Category 3 (appointment clinically indicated within 365 days)

  • moderate to severe eczema in specific patterns of involvement: eyelid/facial/hand dermatitis

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.

  • reason for referral
  • duration and history of symptoms
  • management to date, compliance with and response to treatment, including natural therapies
  • details of any previous consultations
  • relevant pathology
  • past medical history
  • current medications
  • relevant family history, including family history of atopy
  • general history including consideration of faltering growth/failure to thrive
  • possible trigger factors
  • effect of itch on sleeping pattern
  • known allergies, reactions and any formal allergy testing
  • current diet, food eliminated, past or present
  • social circumstances including effect on family
  • adherence to therapy

Clinical management advice

Everyday treatment

  • family education on the chronic nature of the disease, the need to management rather than cure
  • non-soap wash, not soap
  • use an eczema shampoo or non-soap-based wash for hair washing
  • use a bath oil
  • bath patient at least once daily with lukewarm water
  • pat skin dry after bath and apply cream/ointment to moist skin
  • moisturise all over up to four times a day using a greasy and non-irritating emollient, i.e. Dermeze ointment/Epaderm ointment
  • educate family on the environmental aggravators of eczema including the effect of heat (overdressing, heaters, hot baths), prickle (wool, tags on clothing, rough fabrics) and dryness (soaps, heating)

Flaring treatment

  • topical corticosteroids, when skin red or itchy
    • face - mild steroid i.e. hydrocortisone 1% ointment twice a day or an anti- inflammatory cream i.e. pimecrolimus cream twice a day.
    • body and scalp - may use betamethasone valerate 0.02%, mometasone furoate 0.1% ointment or methylprednisolone aceponate 0.1% ointment once a day.
  • prescriptions can be written for multiple tubes of corticosteroid to be given at once without calling the PBS (PBS streamlined authority). Prescribe what the child needs in one week then multiply by four to cover the month. Up to 10 tubes with five repeats can be ordered this way.
  • wet wraps/dressings if corticosteroids have not significantly cleared the eczema in 48 hours, or if the child is waking during the night because of the itch, see Wet dressings for eczema (PDF 142KB)
  • cool compresses for immediate relief of itch
  • crusts may need removal. To remove crusts, soak in the bath for 20 minutes and then wipe away. Topical treatments can then be started.
  • antibiotics, when bacterial infection is indicated. This should be based on clinical features (yellow crusting/surrounding erythema). Swabs in most patients with atopic dermatitis will show colonisation with Staphylococci. Swabs should thus be used to determine sensitivity and resistance, rather than in deciding if antibiotics are required.
    • six day course of oral antibiotics i.e. Cephalexin or flucloxacillin, if not contraindicated.
    • avoid topical antibiotic preparations (e.g. Bactroban).
  • antivirals. When viral infection is indicated 10-day course of Acyclovir, consider emergency presentation if widespread
  • antihistamines
    • sedating antihistamines are not recommended for children under two years of age.
    • if food allergies are suspected, parents should keep a food diary and record flare-ups, detailing ingestion of food and onset of reaction. If food allergies are suspected, prick testing can be undertaken by the paediatric immunology team, not dermatology

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.