Skin infection

Red flags

Consider urgent referral for patients with the following

Evidence of tuberculosis involvement
- Consider Infectious Diseases referral
Extensive infected crusted scabies
- Consider Infectious diseases referral
Deep or progressive ulceration
- Consider General Surgical referral

The following features may lead to more urgent categorisation

Extensive or severe involvement
Consider Infectious diseases referral

Conditions in this category include:

Recurrent superficial/ deep skin infection
- Impetigo
- Boils/ abscesses
- Extensive infected scabies
- Ulcers
- Tuberculosis infections
  - Refer to Infectious Diseases

Other important information for referring practitioners

Medical management

For recurrent skin infections screen for predisposing chronic diseases e.g.
- Diabetes,
- Immunodeficiency especially chronic granulomatous disease, hyper IgE syndrome
- Inflammatory bowel disease (pyoderma gangrenosum)
- Hiradenitis suppurativa
Advise the patient on Staphylococcus eradication program utilising regular skin antisepsis, use of muciprocin ointment to nose, chlorhexidine to groin, axillae and chlorhexidine hand scrub use
- Swab skin, nose axillae and groin to exclude MRSA especially in patients with recent hospital stay or health workers
Treat any underlying chronic skin condition e.g. eczema

Other conditions

Conditions in this category include:

Warts
Vitiligo
Discoid lupus
Nail conditions
- Onychogryphosis
- Nail dystrophies
- Sub- ungula fibroma or other tumours
Lichen planus
Pemphigus
Pemphigoid

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Presence of any Red Flags
Reason for referral
History of condition
- Duration
- Extent of infection
- Previously trialled medications and reason for failure
Include any bacterial swab results or skin biopsy/scraping results

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use