When should I consider a referral to a dermatologist for a patient with a rash?

Consider referring a patient with a rash to a dermatologist in the following situations:

• If the rash is suspected to be a skin cancer, such as a pigmented lesion with a weighted 7-point checklist score of 3 or more, nodular melanoma, or lesions suspicious for squamous cell carcinoma, refer urgently via a suspected cancer pathway ¹.
• For basal cell carcinoma, consider routine referral unless there is concern that delay may significantly impact due to lesion site or size ¹.
• In children under 12 with atopic eczema, refer for specialist dermatological advice if the diagnosis is uncertain, if management has not controlled the eczema satisfactorily (e.g., frequent flares or adverse reactions to emollients), if eczema on the face has not responded to treatment, or if contact allergic dermatitis is suspected ².
• Refer children with atopic eczema if it causes significant social or psychological problems, is associated with severe or recurrent infections, or if growth is not on expected trajectory ².
• Urgently refer children with severe atopic eczema not responding to optimal topical therapy after 1 week or if bacterially infected eczema treatment has failed ².
• Immediately refer children if eczema herpeticum is suspected ².