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Planned Care Services

Dermatology

Referral Acceptance

Dermatology referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to triage referrals can be found below under Access Criteria.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Skin lesions that may require removal are processed via the Coordinated Primary Options (CPO) programme. Those referrals are triaged and allocated to appropriately credentialled practitioners, including general practitioners with a special interest in skin surgery, and plastic surgeons.

Referral acceptance is a follows:

For disease information please refer to dermnetnz.org

First Specialist Assessments

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 3

Declined

Waiting priority 4

Declined

 

Access Criteria

Note: Access criteria that determine prioritisation primarily on the referral diagnosis have their limitations and this is acknowledged.  For those referrals in which the referring doctor has not been able to make a confident diagnosis it may be difficult, or impossible, to apply these ACA criteria.  It is therefore stressed that these are guidelines only and that clinical judgement must be applied in all cases in which they are used.

Immediate and urgent cases must be discussed with the Specialist or On Call Medical Officer in order to get appropriate prioritisation and then a referral letter sent with the patient, faxed or emailed.  The times to assessment may vary depending on size and staffing of the department.

Referral Guidelines: Dermatology

Category

Criteria

Examples
(not an exhaustive list)

1 - Urgent
  • Severe blistering disorders.
  • Severe psoriasis.
  • Toxic untreated erythema.
  • Severe Skin infections.
  • Cutaneous failure.
  • Sepsis.
  • Most inpatient referrals except lesions.

  • Erythrodermic psoriasis

  • Generalised pustular psoriasis

  • Eczema herpeticum

  • Toxic epidermal necrolysis

  • Steven-Johnson’s syndrome

  • Pemphigus vulgaris

  • Exfoliative/Erythrodermic dermatitis

2 - Semi-urgent
  • Severe but stable dermatoses, such as psoriasis and eczema

  • Pediatric connective tissue or autoinflammatory disease

  • Adverse drug reactions

  • Generalised dermatitis

  • Bullous Pemphigoid

  • Generalised severe psoriasis

  • Pediatric morphea/linear scleroderma/Parry-Romberg syndrome

  • Pediatric dermatomyositis

3 - Non-urgent
(Not accepted)
  • Severe scarring nodular cystic acne. Failed primary care management

  • Skin diseases (psoriasis, eczema, rashes) that are widespread or debilitating. Failed primary care management

  • Most severe connective tissue diseasesGeneralised dermatitis

    Progressive psoriasis

    Progressive psoriasis.
  • Progressive psoriasis
  • Eczema.
  • Lupus.
  • Scleroderma.
  • Allergic contact dermatitis.
  • Severe acne with scarring.
  • Unresponsive acne with scarring.
  • Severe pediatric vitiligo

4 - Routine
(Not accepted)

  • Skin diseases (psoriasis, eczema, rashes) that are widespread but stable

  • Venous ulceration

  • Unresponsive acne without scarring

  • Mild/moderate acne

  • Longstanding conditions (eczema, psoriasis) with moderate symptoms

  • Minor skin infections

  • Cosmetic conditions

  • Benign nuisance lesions

  • Actinic Keratoses

     

  • Seborrheic Keratosis

  • Atypical naevi
  • Epidermoid cysts
  • Dermatofibromas
  • Syringomas
  • Warts
  • Most vitiligo 

Notes:

  • From September 2010, all skin lesions should be referred via the PHO skin lesion service in the first instance.Lesions requiring specialist assessment and treatment in the hospital should still be sent to the PHO skin lesion service for grading. Dermatology is NOT currently contracted for assessment or treatment of skin cancers with the exception of organ transplant recipients. All patients with suspected or proven skin cancers should be referred directly to PHO or surgical services for assessment and treatment.
  • The DHB does not offer a skin surveillance service.
  • (Depending on facilities available, skin cancers are booked at a surgical procedure clinic.  This may include removal of large or multiple tumours/flaps/grafts.  When more complex intervention is required or facilities are not available, appropriate referral is made).
  • Children falling into Category 1 need to be referred immediately to a paediatric service for assessment, as many of these conditions will require hospital admission.