Download Dermatology conditions should be treated in primary care where

Dermatology conditions should Dermatology
be treated in primary
care where
possible.
Referral
Guidelines
When specialist advice or treatment is needed, patients can be referred to any of the local Community
Dermatology Services, who provide a comprehensive dermatology service to patients with a skin rash or
skin lesions.
However, there are a few exceptions to this as set out below.
ANY SUSPECTED MM OR SCC SHOULD BE REFERRED URGENTLY ON A ‘2 WEEK RULE’
PROFORMA TO SECONDARY CARE.
SKIN RASHES
MANAGE IN PRIMARY CARE
Examples of skin rashes that should be routinely managed in primary care include the following:
 Mild/moderate acne not requiring Isotretinoin (Roaccutane)
 Mild/moderate childhood atopic eczema
 Mild discoid eczema, xerosis or generalised pruritus
 Plaque psoriasis confined to discrete areas
 Recurrent bacterial infections/tinea including pityriasis versiculor
 Urticaria/angioedema
 Alopecia areata (always refer if there is diagnostic doubt or if scarring is present)
 Androgenic alopecia
 Hirsutism
 Leg ulcers – patients can only been seen in the community service to exclude basal cell carcinoma or
Bowen’s Disease.
REFER TO THE COMMUNITY DERMATOLOGY SERVICE
Referral to the Community Dermatology Services can be made for patients with skin rashes or general skin
problems:
 If standard treatment fails to treat the problem
 If there is doubt about the underlying diagnosis
REFER URGENTLY INTO ACUTE (SECONDARY) CARE
Patients with life-threatening severe inflammatory skin disease should be referred as an emergency (via A&E out
of hours) i.e.,
 Generalised erythroderma (>70% body surface area)
 Severe drug reactions
 Severe erythema Multiforme/Steven’s Johnsons Syndrome
 Generalised pustular psoriasis
 Severe bullous pemphigoid (>30% blisters)
 Moderate/severe vasculitis (necrotic skin lesions/systemic symptoms)
The initial assessment of a patient with a stable inflammatory skin disease can be provided by either community
service and the patient will generally be triaged to a consultant clinic. Please use the CWS Community GP referral
form Patients requiring ongoing medical supervision of systemic immunosuppressive or biologic treatments can be
referred on to secondary care, and therefore the patient will be referred on from the community service.
SKIN LESIONS
MANAGE IN PRIMARY CARE
Skin conditions that are eligible for removal under the ‘Minor Surgery Locally Commissioned Service’ (also see
appendices) are shown on the CCG website http://www.coastalwestsussexccg.nhs.uk/cwsccg-locally-commissionedservices
BENIGN SKIN LESIONS AND ‘LOW PRIORITY PROCEDURES’
Asymptomatic benign lesions should be considered cosmetic and the patient should be either advised that
treatment is not routinely available via the NHS or an application should be made under the ‘Individual Funding
Request’ process.
NB The following treatments and procedures are not routinely funded in the community services:
 Viral warts
 Acne scarring
 Chemical peels
 Dermabrasion of skin
 Electrolysis
 Hirsutism treatments
 Melasma/Chloasma
 Botulinum toxin therapy for hyperhidrosis
 Laser therapy/laser treatment for aesthetic reasons Laser tattoo removal
 Removal of benign asymptomatic skin lesions (includes papillomas, seborrhoeic keratosis, lipomas and
sebaceous cysts)
REFER TO THE COMMUNITY DERMATOLOGY SERVICE



Skin lesions where there is diagnostic doubt and the referral is warranted to exclude a skin cancer or
underlying inflammatory process
Basal Cell Carcinoma
Benign skin lesions that cause severe symptoms interfering with quality of life
Examples would include:
 A recurrent discharging cyst
 A recurrent bleeding from a vascular angioma
 A recurrent infection/bleeding from an irritated seborrhoeic keratosis
Please note: All referral letters must state that the referral is warranted because of diagnostic doubt or medical
symptoms to be accepted and seen within the community service.
REFER TO SECONDARY CARE
Any patients with suspected Malignant Melanoma or Squamous Cell Carcinoma should be referred directly into two
week
rule
referral
clinics.
For
WSHFT,
please
use
the
referral
proforma
at:
http://gp.westernsussexhospitals.nhs.uk/2-week-rule/
All referrals made to the community service will be triaged. Any referral considered inappropriate for a community
setting will be re-directed to secondary care service as an urgent referral. Under these circumstances, both the GP
and the patient will be informed that this course of action has been considered necessary.
PHOTOTHERAPY
Phototherapy services are provided by all Community Dermatology Services for inflammatory skin disease.
October 2014