When should I consider referring a patient with impetigo to a dermatologist?

Consider referring a patient with impetigo to a dermatologist or specialist if:

• The impetigo is difficult to treat, such as bullous impetigo or impetigo that recurs frequently.
• The patient is immunosuppressed and the infection is widespread.
• The patient is systemically unwell or at high risk of complications.
• The diagnosis is uncertain and differential diagnoses have been considered.
• Meticillin-resistant Staphylococcus aureus (MRSA) infection is suspected.

Referral urgency depends on clinical judgement, with urgent assessment needed if serious complications like deep soft tissue infection or sepsis are suspected. Usually, referral is not necessary for uncomplicated impetigo, but specialist advice should be sought for severe or complicated cases.

In summary, refer when impetigo is severe, recurrent, complicated, uncertain in diagnosis, or associated with systemic illness or immunosuppression.

Patient education on hygiene and treatment adherence is important if referral is not indicated.

References: NICE CKS