What criteria should I use to determine if a patient with pemphigus vulgaris requires referral to a dermatologist?

Referral criteria for a patient with pemphigus vulgaris to a dermatologist include:

• When the diagnosis is uncertain or needs confirmation, as pemphigus vulgaris is a rare condition and diagnosis may only become clear when bullous lesions appear.
• When systemic corticosteroid treatment or other specialist therapies are required, which necessitates specialist management.
• When the disease is severe or progressing, requiring specialist assessment and management.
• When there is involvement of mucous membranes or extensive skin involvement that cannot be managed adequately in primary care.

Referral allows for confirmation of diagnosis and initiation of appropriate systemic treatment, which is critical in pemphigus vulgaris management.

These criteria are based on expert opinion and good clinical practice, recognising the rarity and complexity of pemphigus vulgaris and the need for specialist input to optimise outcomes.

References: NICE CKS