Dermatology Clinics - referral help

Service Description

Dermatology is the study of the skin, skin disease and cutaneous manifestations of systemic diseases. Many subspecialties exist with dermatology, highlighting the scope and breadth of this area of medicine.

Subspecialties

Inflammatory, infectious and immune disorders of skin, photodermatoses, genodermatoses and skin cancers.

The Royal Melbourne Hospital Department of Dermatology provides a general and specialised service for a wide range of these skin disorders. Combined clinics with other specialties such as immunology, nephrology, genetics and plastic surgery, ensure a multidisciplinary and holistic approach to patient care.

Consultant Dermatologists

• Dr George Varigos (Head of Unit)
• Dr Anna Braue
• Dr Con Doliantis
• Dr David Gill
• Dr Anne Howard
• Dr Vanessa Morgan
• Dr Jenny Nicolopoulos
• Dr Gayle Ross
• Dr Laura Scardamaglia
• Dr Edward Upjohn

Urgent referrals

For urgent referrals, Please call The RMH switchboard on 9342 7000 and ask for the dermatology registrar

• Acute drug eruptions
• Stevens Johnson syndrome / Toxic Epidermal Necrolysis
• Erythroderma
• Disseminated HSV infection / Eczema herpeticum
• Generalised pustular psoriasis
• Acute bullous eruptions
• Vasculitis
• Severe cystic acne
• Suspected melanoma
• Biopsy proven melanoma

Urgent appointments for the melanoma clinic are via plastics intern.

Routine referrals

Condition	Symptoms	Notes
Severe Acne	Extensive disease or nodules and scars Poor response to at least 6 / 12 of two oral antibiotics and topicals	Assessment / investigation recommended before referral:
Alopecia	Persistent or extensive alopecia Scarring alopecia Diagnostic uncertainty
Connective Tissue diseases	Morphoea (cutaneous lupus) SLE Dermatomyositis Mixed connective tissue Opinion and management	FBE, UEC, LFT, ANA, ESR
Eczema	Failure to respond to continuing use of moderately potent steroids Chronic lichenified eczema Eczema herpeticum ** Acute infected eczema Erythroderma **
Hyperhidrosis	Generalized hyperhidrosis Severe focal hyperhidrosis Patients who have failed a good trial of AlCl antiperspirants for palms and soles.	Check medications prior to referral. The most common drug to induce hyperhidrosis are the SSRI’s.
Molluscum contagiosum	Extensive, painful or inflamed lesions Immunosuppressed patients
Non-melanoma skin cancer
SCC	Urgent referral for rapidly growing tumours ** High risk sites (lips, ears, recurrent lesions) High risk patients (i.e. Immunosuppressed) Diagnosis uncertain
BCC	Suspected BCC Morphoeic or sclerosing BCC High risk sites (i.e. nasolabial folds) High risk patients (i.e. Immunosuppressed) Patients with multiple tumours
Solar keratosis / Bowen’s disease	Diagnosis uncertain (SCC until proven otherwise) Painful or rapidly growing lesions Extensive disease Extensive sun damage Treatment failures Immunosuppressed
Nail dystrophy	Suspicion of sub-ungal tumors Failure of fungal infections to respond to treatment	FBE, UEC, LFT, TSH, T4, Fe studies
Pruritis	Diagnosis uncertain Uncontrolled itch	(Exclude: Fe deficiency anaemia, thyroid disease, chronic renal failure, liver disease, lymphoproliferative disease, drug reaction.)
Psoriasis	Diagnosis uncertainty Extensive disease Occupational disability with excessive time off school or work Involvement of sites that are difficult to treat (palms, soles, genitals) Failure of appropriate topical treatment Severe or recalcitrant disease requiring systemic therapy Erythrodermic psoriasis ** Pustular psoriasis **	FBE, UEC, LFT. (For patients being considered for systemic treatment)
Porphyria	Diagnosis uncertain Fragile skin and blisters on sun exposed sites.	FBE, UEC, LFT, faecal and urinary porphyrins, RBC porphyrins
Rosacea	Severe unresponsive disease Rhinophyma Severe telangiectasia Keratitis: Refer to Ophthalmology
Urticaria	Persistent urticaria for three months, unresponsive to three different antihistamines each for 4-6 weeks Urticarial vasculitis with associated joint pains, persistent wheals or bruising Angioedema: consider referral to Immunology

Referral Process

All referrals must include:

• Level of urgency
• Name, age, date of birth
• Address
• Contact telephone numbers
• Medicare number
• Specific clinical problems requiring consultation
• Preferred Language. Please indicate if interpreter is needed
• Copy of results of relevant investigations performed within the previous 12 months
• List of current medications

How to refer

Fax to 03 9342 4234. VSRF preferred - see the General Practice Victoria website for more information

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