When should I consider referring a patient with impetigo to a dermatologist?

Consider referring a patient with impetigo to a dermatologist or specialist if:

• There is diagnostic uncertainty and differential diagnoses have been considered.
• The impetigo is difficult to treat, such as bullous impetigo or impetigo that recurs frequently.
• The patient is immunosuppressed and the infection is widespread.
• The patient is systemically unwell or at high risk of complications.
• Meticillin-resistant Staphylococcus aureus (MRSA) infection is suspected.
• Serious complications such as deep soft tissue infection or sepsis are suspected, requiring urgent assessment.

Referral urgency depends on clinical judgement, with hospital referral considered for severe or complicated cases requiring parenteral antibiotics. For most patients with uncomplicated impetigo, referral is usually not necessary, and management can be done in primary care with appropriate treatment and hygiene advice.

Patient information and hygiene measures should be advised to aid healing and reduce spread, and worsening or non-resolving cases should be reassessed for possible referral.

These recommendations are based on NICE guidelines and CKS good clinical practice.

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