P088 Reasons for new patient attendances in general dermatology clinics in a secondary care service

Abstract

Evolving population demographics and epidemiology of skin diseases, and modern filtering of outpatient referrals via teledermatology (Advice and Guidance), may be contributing to a changing case mix in general dermatology clinics. The aim of this retrospective observational study was to provide a fresh analysis of the range of dermatological conditions seen in a secondary care dermatology service. New patient cases on the Referral to Treatment pathway seen in general dermatology clinics in January to May 2025 were identified retrospectively using the hospital’s electronic health record. Attending patients had been deemed unsuitable for management with Advice and Guidance. Referral letters were scrutinized to gather data on each patient’s age, sex, ethnicity and reason for referral. The latter was categorized as either diagnosed (referred for management) or undiagnosed (referred for diagnosis). In total, 204 cases were identified, with a median age of 40 years; 64.7% were female. The ethnic breakdown was 46.6% White, 9.3% Asian, 17.2% Black, 22.5% other and 4.4% not stated. In total, 85 of 204 cases (41.7%) had an established general practitioner diagnosis and 119 of 204 cases (58.3%) were referred for diagnosis. Of the cases already diagnosed, acne was the most common condition (32.9%), followed by atopic dermatitis (23.5%), psoriasis (20.0%), hidradenitis suppurativa (5.9%) and vitiligo (2.4%), with other conditions making up 15.3%. Undiagnosed patients were referred most frequently for rashes (43.7%), lesions (26.1%), pigmentary disorders (11.8%), hair loss (8.4%), genital dermatoses (4.2%), pruritus (4.2%) and nail disorders (1.7%). The majority of new patients attending the general dermatology clinic were for diagnostic uncertainty. Compared with previous studies, acne appeared to be a more common reason for referral, with atopic dermatitis and psoriasis continuing to represent a significant proportion of the caseload. Hidradenitis suppurativa appears to be under-represented in referrals. The patient case mix in dermatology clinics should be assessed periodically to detect trends in referral patterns and help plan delivery of dermatology services.