عيادات الجلدية

Routine

Urgent (< 5 days)

Persistent rashes or dermatitis not responding to ≥ 6 weeks of appropriate treatment (e.g. eczema, seborrheic dermatitis, contact dermatitis, rosacea)

Psoriasis or lichen planus requiring systemic treatment or phototherapy

Suspected autoimmune or bullous diseases (e.g., cutaneous lupus, vitiligo with rapid spread)

Scarring alopecia or hair disorders (not clearly telogen effluvium, or caused by reversible nutritional or metabolic factors)

Moderate–severe acne unresponsive to topical + oral agents available in PHCs

Chronic urticaria > 6 weeks not responding to 2^nd gen antihistamines

Calluses or warts unresponsive to repeated salicylic acid or previous cryotherapy

Unexplained nail changes suggestive of fungal infection, psoriasis, or melanoma

Need for diagnostic confirmation or skin biopsy (Urgent if malignancy is suspected)

Cosmetic dermatology evaluation (e.g., keloid scar, hyper/hypopigmentation)

Skin conditions impacting mental health or quality of life, despite PHC management

Recurrent skin infections (boils, abscesses) despite good hygiene and antibiotics.

Suspicious benign lesions (e.g., seborrheic keratoses with atypical appearance)

Severe, uncontrolled symptoms (e.g., intense pruritus, pain, widespread discomfort, sleep disturbance) not responding to appropriate PHC treatment

Suspected skin cancer (melanoma, SCC, BCC) — non-healing lesions, asymmetry, pigmented lesions with ABCDE features

Rapidly enlarging, ulcerating, or bleeding masses/lesions with unclear diagnosis

New-onset or worsening blistering disorders (e.g., early pemphigus vulgaris or bullous pemphigoid without systemic signs)

Severe or worsening psoriasis (non-erythrodermic) with significant impact on daily function or quality of life

Unexplained purpuric or vasculitic rash (e.g., palpable purpura, livedo reticularis) not associated with systemic instability

Persistent or widespread skin infections (e.g. tinea) requiring systemic treatments

Painful or persistent genital ulcers or vesicular eruptions
(e.g., first episode of HSV, suspected syphilitic chancre)

Persistent or recurrent urticaria with facial swelling or discomfort (but no airway compromise)

Neonatal or infant skin rash with systemic symptoms or blistering

Suspicion of cutaneous lymphoma or other rare dermatoses

• Always attempt a comprehensive 6-week conservative treatment trial for common conditions (e.g., eczema, acne, psoriasis) — with appropriate drug classes, potency, frequency, and patient education. Many referrals can be avoided when incomplete or superficial treatment attempts are replaced with a proper, Evidence-based management.

• Document prior treatments and durations (e.g., topical steroid class, antifungal course)

• ER referral is indicated for any acute, severe, or extensive dermatologic and soft-tissue disorder associated with significant morbidity or risk of rapid progression. Examples include life-threatening drug reactions (Stevens–Johnson syndrome, toxic epidermal necrolysis), severe infections with potential ocular or systemic complications (herpes-zoster ophthalmicus, necrotizing fasciitis), and other widespread or rapidly deteriorating skin condition.