Specialty: Dermatology
Age group: Adult
Direct to an emergency department
- Anaphylaxis
- Any rash causing widespread erythema of the skin with signs of systemic illness
- High fever, lymphadenopathy, eosinophilia and systemic illness that may indicate a drug hypersensitivity syndrome
- Mucosal erosions, skin pain, blisters, pustules and/or fever that may indicate the development of toxic epidermal necrolysis
- Suspected Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN).
Criteria for referral to public hospital service
- Blistering or erosive skin eruptions
- Rapidly evolving severe or widespread skin eruption with uncertain diagnosis or possibly linked to an adverse drug reaction
- Persistent rash of unknown cause that has not responded to medical management.
Information to be included in the referral
Information that must be provided
- Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
- Findings on physical examination
- Details of onset, duration, site (e.g. oral and affecting food intake, genital location), size and any recent changes in size of blisters or lesions
- Details of previous management including the course of treatments and outcome of treatments
- Relevant medical history and comorbidities
- Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs) and any medicines associated with the patient’s symptoms
- Patient’s age
- If the patient is pregnant and if the skin condition is thought to be related to the pregnancy
- If rash of unknown cause, biopsy results.
Provide if available
- Colour photograph(s) – with patient’s consent where secure image transfer, identification and storage is possible. These images often assist with identifying clinical urgency and the most appropriate specialist clinic or service
- Urea and electrolytes
- Full blood examination
- Liver function tests
- Histology results
- If the person identifies as an Aboriginal and/or Torres Strait Islander
- If the person is neurodiverse, gender diverse or has a disability
- If the person has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter).
Additional comments
The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.
The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Skin eruptions that have resolved or been adequately managed.
Updated