Derm consult triage

Should I Consult Dermatology?

A concise triage aid for serious rashes, blistering disease, drug reactions, malignancy clues, autoimmune skin disease, and complex infections.

Educational only Draft last updated June 5, 2026

Common presentations

SJS/TEN DRESS Bullous rash Purpura / necrosis Eczema herpeticum Skin biopsy

Before you consult

Make the Derm Question Visible

Send usable photos

When feasible, include distribution, close morphology, and key sites such as mucosa, palms/soles, nails, folds, and the most active lesion.

Describe the pattern

Name morphology, distribution, timing, spread, symptoms, mucosal involvement, systemic features, immune status, and medication timeline.

Check for hard stops

Use local urgent pathways for instability, sloughing skin, mucosal involvement, necrosis, rapidly progressive infection, sepsis concern, or airway concern.

Ask a better question

Frame the consult around what Derm can change: diagnosis, biopsy site or handling, disposition, isolation, immunosuppression, antimicrobial pathway, or follow-up timing.

Use this when the rash question involves serious drug reaction, mucosa or sloughing, blistering, purpura or necrosis, atypical infection, biopsy site selection, systemic disease, or disposition-changing diagnostic uncertainty.

Common low-yield consults

Usually Better as Photos, Standard Care, or Outpatient Derm

Copyable consult message

Derm Consult Dotphrase

Reason for Consult: ***
HPI: ***

Morphology: ***
Distribution: ***
Involvement of mucosa/palms/soles: ***
Systemic features: ***
Meds associated: ***
Pending: ***

Images available in chart
Callback: ***
Thank you!

Best practices for Derm consults

  • Upload photos when possible: distribution, close morphology, and key sites such as mucosa, palms/soles, nails, and involved folds.
  • Describe morphology: macules, papules, plaques, pustules, vesicles, bullae, erosions, ulcers, purpura, scale, crust, retiform pattern, tenderness.
  • Include time course, rate of spread, immune status, and medication starts/stops from the last 8 weeks.
  • State what Derm would change: diagnosis, biopsy site/technique, disposition, immunosuppression, isolation, antimicrobial/antiviral pathway, or follow-up timing.

Rash categories

Describe the Pattern Before the Consult

Morbilliform / drug-like

Widespread red spots or bumps, often trunk-predominant, after medication or viral illness.

  • Derm is more reasonable with fever, facial edema, eosinophilia, mucosa, or organ injury.
  • Usually not inpatient Derm when mild, stable, and without red flags.

Blistering / erosive

Blisters, raw skin, peeling, mucosal erosions, painful dusky patches, or unclear autoimmune blistering disease.

  • Derm may change biopsy technique, wound care, and disposition.
  • Ophtho or burn/ICU may be concurrent for eyes or extensive detachment.

Purpuric / necrotic / retiform

Non-blanching purple spots, net-like violaceous rash, necrosis, livedo, painful ulcers, or rapidly worsening lesions.

  • Derm may help separate vasculitis, vasculopathy, infection, embolic disease, and mimics.
  • ICU, ID, surgery, Rheum, nephrology, or heme may be first or concurrent.

Vesicular / pustular / punched-out

Grouped vesicles, pustules, punched-out erosions, disseminated lesions, eschars, or infection-like morphology.

  • Think eczema herpeticum, disseminated HSV/VZV, mpox-like eruption, deep fungal disease, or atypical infection.
  • Derm may change biopsy/culture site, testing, isolation, or disposition.

Erythroderma / severe scaling

Most of the body is red or scaly, with admission-level skin burden, swelling, warmth loss, pain, or pruritus.

  • Derm may change biopsy, topical regimen, wet wraps, systemic therapy discussion, or CTCL evaluation.
  • Stable chronic eczema or psoriasis without systemic instability is different.

Autoimmune / systemic pattern

Skin findings that point toward systemic disease: dermatomyositis, lupus-like, vasculitic, neutrophilic, or ulcerative patterns.

  • Derm is more useful when biopsy changes Rheum, oncology, ID, or immunosuppression decisions.
  • State weakness, dysphagia, dyspnea, arthritis, renal/GI symptoms, and infection concerns.

Malignancy / paraneoplastic concern

Rapidly changing or nonhealing lesion, erythroderma with lymphadenopathy, CTCL concern, dermatomyositis signs, or severe unexplained pruritus.

  • Derm may change biopsy site and systemic workup direction.
  • Routine stable skin cancer screening is usually outpatient.

Common stable rash

Stable eczema, psoriasis, seb derm, acne, rosacea, tinea, intertrigo, uncomplicated urticaria, mild exanthem, routine mole check, or uncomplicated cellulitis/abscess.

  • Usually not inpatient Derm without hard stops or disposition-changing diagnostic uncertainty.
  • Escalate if pain, mucosa, blistering, necrosis, systemic illness, immunocompromise, or rapid progression appears.

Derm consults FAQ

Common Derm Questions

What makes a Derm consult appropriate in the ED or hospital?

Derm is most useful when morphology changes diagnosis, biopsy site or technique, disposition, systemic therapy, isolation, malignancy/systemic workup, or follow-up timing.

What are hard signs of a serious rash?

Systemic illness, mucosal involvement, skin pain, dusky or targetoid lesions, sloughing, widespread bullae, purpura, necrosis, retiform rash, organ injury, immunocompromise, or rapid progression.

When is outpatient Derm or standard care usually enough?

Common stable rashes without hard stops, systemic illness, immunocompromise, admission-level burden, or disposition-changing diagnostic uncertainty often do not need inpatient Derm.

References

Educational tool only. SIC provides clinician-facing educational consult-triage references. SIC does not diagnose, treat, prevent, cure, or mitigate disease and is not a substitute for clinical judgment, local guidelines, institutional referral pathways, or recommendations from your dermatology department. See disclaimer and how SIC works.