Diagnosis

PCP Evaluation/Management Options

PCP Guidelines for Referral to Specialist

Acne/Rosacea

Treat with topical medications including:

Benzoyl peroxide

Antibiotics

Retin-A

Treat with oral broad spectrum antibiotics.

If other treatment modality fails, treat wit Accutane for nodulocystic acne if the physician if familiar with treatment schedules. Take scrupulous precautions for avoidance in women of childbearing potential.

Use at least three modalities over a three-month period unless severe, scarring acne.

Treat recurrent acne with a regimen that has been successful in the past whether originated by the primary care physician or dermatologist.

Consider consultation or referral if, after three months, the problem has not be resolved, or improvement has ceased, or for severe cystic acne.

Refer if inexperienced in intralesional corticosteroid injections or the use of Accutane, or if active scarring is thought to require a procedure.

Actinic Keratoses

Treat with liquid nitrogen, Efudex, or cryotherapy if trained.

Refer lesions that persist or recur.

Refer large or complicated lesions, lesions in immunocompromised patients, and lesions in high-risk areas including: head, neck, face, ears, genital area, and burn scars.

Basal Cell or Squamous Cell Carcinomas

Refer for biopsy and treatment.

Common Skin Disorders

If CLIA certified, perform Tzank smears, bacterial and fungal cultures.

Perform KOH preparations if trained and experienced.

Perform biopsies if skilled, all of which must have dermatopathological examination.

Administer cryotherapy with liquid nitrogen if available and trained.

Refer for intralesional injections.

Refer for biopsies of facial lesions.

Refer for any recommended modalities or testing if not trained and experienced.

Cosmetic Conditions (liver spots, spider veins, wrinkles, skin tags, uncomplicated cysts, flat asymptomatic warts, stable lipomas, seborrheic keratoses, non-inflammed papillomas, hereditary hypertrichosis, tattoos, and non-changing pigmented lesions without special risk).

Explain to patients that the removal of certain lesions for nondiagnostic purposes is usually considered cosmetic by carriers and may not be covered.

Dermal Injuries

Treat minors burns, lacerations, bites and stings.

Hypertrichosis and Hair Loss

Refer for extensive alopecia areata or hair loss associated with infection or systemic disease.

Inflammatory Dermatoses (including allergic dermatitis, atopic dermatitis, contact dermatitis, perioral dermatitis, psoriasis, and seborrheic dermatitis).

Refer psoriasis patients who are considered to be candidates for phototherapy because of extensive involvement or for unsatisfactory response topical treatment.

Refer other conditions if the cause is unclear or if here has been an unsatisfactory response to treatment.

Nail Problems

Treat ingrown nails, nail fungus, trauma, onychia and paronychia.

Refer to an orthopedist or podiatrist for osteomyelitis if surgical intervention is anticipated.

Nevi

Biopsy if experienced.

Refer for biopsy if not experienced.

Refer lesions suggestive of melanoma.

Skin Infections (including, but not limited to cellulites, dermatophytoses, herpes simplex, herpes zoster, impetigo, pediculosis, pityriasis rosea, scabies, and tinea versiocolor)

Treat symptomatically.

Refer to dermatologist if the diagnosis is uncertain, or there has been an unsatisfactory response to treatment.

Refer to ophthalmologist for ophthalmic involvement with herpes simplex or herpes zoster.

Verrucae, Molluscum Contagiosum, Skin Tags, Seborrheic Keratosis

Treat with topical suspensions or liquid nitrogen if skilled and treatment is thought necessary.

Refer if the treatment has been unsuccessful in symptomatic or functionally impaired patients.