Dermatological ‘red flag’ conditions

Nurses working in any clinical setting require the skills to identify which skin conditions require immediate emergency referral or a response by other practitioners with appropriate advance practice skills and the relevant scope of practice. Some of the key ‘red flag’ conditions, which require prompt medical referral, are listed below:

• Viral rashes if systemically unwell
• Any rash that is purpuric in nature
• Any rash associated with either temperature, multi-lymphadenitis headaches or stiffness of neck
• Insect bites or stings that have a significant area of cellulitis or signs of vascular tracking
• If the swelling from insect bites or stings compromises the patient’s airway (to the face or neck)
• Any sign of pharyngeal/facial swelling, difficulty in breathing or anaphylactic reaction
• Shingles: herpes zoster
• Raised skin lesions that show signs of infection

Acute dermatological situations which require a rapid treatment response include adverse drug reactions (e.g. toxic epidermal necrosis), herpes simplex affecting the eye, erythrodermic psoriasis – which is a very severe skin condition where there is a risk of shock and death and blistering disorders (e.g. epidermolysis bullosa) and where there is a significant disruption to the skin barrier (see Less common skin conditions).