Derm consult communication
How to Consult Dermatology
What to include when calling Dermatology about rash, blistering disease, drug reactions, mucosal lesions, sloughing skin, or complex skin infection.
Lead With the Decision
What dangerous rash pattern, diagnostic uncertainty, biopsy question, treatment decision, or disposition problem do you need Derm to help with?
Not sure whether the consult is appropriate? Start with the Should I Consult Derm? triage page, then return here before calling.
Before the call
Have These Details Ready
- Morphology in plain language: macules, papules, plaques, vesicles, bullae, pustules, purpura, necrosis, erosions, scale, or sloughing.
- Distribution, body surface area estimate, progression speed, pain, itch, fever, mucosal involvement, palms/soles, genital/ocular symptoms, and Nikolsky or sloughing concern.
- Medication timeline, especially new antibiotics, anticonvulsants, allopurinol, immune therapies, chemotherapy, or recent dose changes.
- Immune status, systemic symptoms, eosinophilia, LFT/Cr abnormalities, cultures, biopsy status, and relevant photos if local policy allows.
- Specific question: severe drug eruption, infection vs inflammatory disease, biopsy site, admission need, wound care, or outpatient timing.
Exam focus
Document the Specialty-Relevant Exam
- Full skin distribution, including mucosa, palms, soles, nails, scalp, and intertriginous areas when relevant.
- Pain vs pruritus, tenderness, skin fragility, bullae, erosions, purpura, necrosis, retiform pattern, or desquamation.
- Fever, facial edema, lymphadenopathy, ocular symptoms, oral/genital lesions, and signs of systemic involvement.
- Clear photo documentation if appropriate and allowed by local policy.
Phone or secure-chat script
A Cleaner Derm Consult Message
I am calling about a [age]-year-old with [rash morphology] involving [distribution] for [duration]. The concerning features are [fever/mucosal lesions/pain/sloughing/palms-solves/systemic labs/immune status]. Medication changes include [timeline]. My question is whether this represents [dangerous diagnosis/biopsy need/treatment or disposition decision].
Common pitfalls
Avoid Low-Signal Consults
- “Rash, please see” without morphology, distribution, medication timeline, or systemic features.
- Skipping mucosal, palm/sole, fever, sloughing, and recent medication checks in a possible severe rash.
- Calling for a stable chronic rash without clarifying what acute inpatient decision Derm can change.
Reference links
Useful Background
Educational tools 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 the relevant specialty department. See disclaimer and how SIC works.