Undiagnosed chronic rash

Red flags

Consider urgent referral possibly to DEM for patients with the following

  • Extensive severe skin involvement
  • Associated systemic symptoms

The following features may lead to more urgent categorisation

  • Extensive involvement

The following is a guide to the diagnosis of chronic rash.

Important Diagnostic Features

  • History
    • Duration
    • Onset
    • Associated with environmental factor
      • Insect bite
        • Scabies
      • Chemical exposure
      • Diet change/food related
    • Associated symptoms
      • GI symptoms
      • Fever/sore throat
      • Arthralias/arthritis
  • Examination
    • Rash
      • Distribution
      • Inflamed/erythematous
      • Pigmented/depigmented
      • Pruritic
      • Urticarial
      • Blisters (superficial/deep)
      • Vesicular
      • Skin broken/weeping
      • Evidence of burrows or pediculosis
      • Secondary infection or primary
      • Nail or hair changes
  • Investigations
    • Woods light
    • Dermoscopy findings
    • Skin scrapings
    • Skin biopsy
    • Skin allergy prick testing
    • Blood tests
      • RAST testing
      • IgE
      • FBC,ESR,CRP
      • Connective tissue antibody screen

Consider the use of a dermatology atlas for spot diagnosis of common rashes.

Referral requirements

A referral may be rejected without the following information.

  • Presence of any Red Flags
  • Reason for referral
  • Relevant clinical history
    • Description of skin condition
    • Sites affected with severity
    • Treatments trialled and reasons for failure
  • Detailed medication history including any allergy
  • If seen previously by Dermatologist include last two letters
  • Occupational history if relevant
  • Family history if relevant
  • Any relevant histology
    • Important if chronic

Additional referral information (useful for processing the referral)

  • Histology especially in chronic skin conditions
  • Skin swabs/ scrapings

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.

  • 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
  • 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
  • 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
  • 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
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • 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.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

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