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

  • moderate to severe acute and chronic Hidradenitis Suppurativa (HS)
  • suspected hidradenitis suppurativa in children and adolescents

Exclusions

  • infected epidermoid cysts – for management in primary care. Cconsider referral to Infectious Diseases if multiple and recurrent
  • mild HS that responds to topicals and/or episodic use of doxycycline/minocycline

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)

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

Additional information to assist triage categorisation

  • prior treatments trialled

Clinical management advice

Lifestyle modification

Smoking and raised body mass index BMI (due to increased skin friction) are identified as significant risk factors in the development of Hidradenitis Suppurativa (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 (two to three months) of Doxycycline (50-100mg/day) for children over the age of 12 can be given during an acute flare. Other agents may be used in younger children (i.e erythromycin) although HS is rare in children under 11 years of age.

Hormonal medications

The anti-androgenic oral contraceptive pills (Yaz, Yasmin, Dianne-35) can often be helpful for teenage girls with HS (i.e. 15 years of age and older), especially if they experience a peri-menstrual flare. Low dose Spironolactone (i.e. 25-100mg daily) can also be helpful in this age group.

Clinical 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.