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Referral guidance

For information on dermatological conditions, their presentation and possible management in primary care, please refer to the PCDS website www.pcds.org.uk

There are some useful intermediate dermatology services within Bristol, including community dermatology nurses and GPwSI. These are:  

Benign skin lesions (eg skin tags, seborrhoeic keratoses, lipoma, dermal naevi, epidermoid cysts, viral warts)

These should be managed by GP's in practice; cosmetic procedures are not funded on the NHS. If there are additional factors, exceptional funding should be applied for before referral to secondary care and the details of the response documented in the referral. 

Two week wait referrals

Suspected melanoma.

Suspected SCC.

Any fast growing tumour of uncertain diagnosis (eg merkel's, DFSP, adnexal tumour, metastasis).

Other skin tumours

Suspected BCC does not need two week wait but ensure SCC is excluded, before referral routinely.

Facial , morphoeic, recurrent BCC's all need secondary care.

BCC's < 2cm on other body site can be excised by accredited primary care physicians. 

Mild to moderate rashes should be managed in primary care:

Mild/Moderate acne, not requiring Isotretinoin.

Mild/moderate atopic eczema.

Discoid eczema, varicose eczema, xerosis and generalized pruritus.

Urticaria.

Fungal infections, recurrent bacterial infections, follicultis.

Pityriasis versicolor.

Pityriasis rosea.

Mild/moderate plaque psoriasis.

Mild gutatte psoriasis.

Alopecia areata/androgenic alopecia.

Hirsuitism.

Rosacea without rhinophyma.

Mild hyperhydrosis - (NB BOTOX currently provided by vascular team NOT dermatology). 

Where diagnostic uncertainty persists, or condition not responding to treatment, refer to secondary care or the intermediate primare care dermatology service. 

Dermatological conditions requiring secondary care referral

Blistering eruptions.

Moderate acne with scarring or severe psychological upset.

Severe nodulocystic acne.

Vasculitis.

Erythroderma.

Rashes associated with systemic upset.

Scarring alopecia.

Severe hyperhidrosis of palms/soles requiring Iontophoresis.

Severe hidradentis suppurativa.

Persistent nail dystrophy with negative nail clippings.