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.

Essential referral 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.

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