ACD advice on categorisation of dermatology patients during COVID-19

Public health

By Mardi Chapman

8 Apr 2020

The Australasian College of Dermatologists (ACD) has provided advice to members on the categorisation of dermatology patients during the COVID-19 pandemic.

The advice is against a background of bans on all but Category 1 and urgent Category 2 surgery and emergency MBS item numbers to encourage use of telehealth for GP and specialist consultations.

As part of its advice, the ACD notes: “All decisions around clinical urgency need to be determined on an individual patient basis taking into consideration patient, practice, clinician factors and government enforced guidelines and/or policies.”

However Category 1 clinic consultations include severe unstable dermatoses, severe skin infectious, suspected melanoma, a clinical history of ulcerated, growing, changing lesions, and severe skin disease causing distress and preventing work or ADLs through itch or pain.

“Examples (include but are not restricted to) severe drug eruptions, cutaneous lymphoma, invasive SCC head and neck, melanoma, infiltrating BCC head and neck, severe psoriasis and atopic dermatitis, pyoderma gangrenosum, hidradenitis suppurativa, severe cystic scarring recalcitrant acne, severe urticaria, cutaneous lupus, severe pemphigoid and pemphigus.”

Category 2 consultations include moderate inflammatory skin disease including psoriasis and atopic dermatitis, moderate acne, superficial/non high-risk SCCs/BCCs, vitiligo, alopecia areata/totalis/universalis and scarring alopecias.

Category 3 consultations to be deferred include benign tumours, cosmetic conditions, most warts, actinic keratosis/actinic field damage, hair loss, nail dystrophy (excluding tumours), most fungal infections and mild localised inflammatory skin conditions not significantly impacting work/ADLs.

Regarding surgery, the advice is that melanoma and high-risk SCC on the head and neck are considered Category 1 while most BCCs and SCCs are Category 2.

The College say when patients are deferred, it is important to have a process to monitor any deterioration or other changes in the patient’s condition which may warrant re-categorisation.

“You may wish to consider directions around communication with patients about signs and symptoms to monitor for, and arranging clinical reviews as needed.”

The ACD advice also includes tips on external signage and messaging at clinics, infection control within premises, and PPE.

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