Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • nil

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

  • Lyell McEwin Hospital (08) 8182 9000, during business hours. After 5:00 pm contact either of the CALHN services. 

Southern Adelaide Local Health Network

Inclusions

  • patchy hair loss (alopecia areata)
  • active scarring alopecia, discoid lupus, lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans
  • rapid onset of hair growth
  • confirmation of diagnosis if required of female pattern hair loss and telogen effluvium, these patients will be then discharged to primary care for ongoing management

Exclusions

  • established female pattern hair loss and chronic telogen effluvium
  • laser hair removal
  • platelet rich plasma
  • male pattern hair loss/androgenetic alopecia (AGA)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • rapid, extensive patchy hair loss e.g. alopecia areata greater than 50% total surface loss

Category 2 (appointment clinically indicated within 90 days)

  • patchy hair loss e.g. alopecia areata 20 to 50% total surface area not responding to standard therapy and requires assessment by a dermatologist
  • new and established scarring alopecia
  • rapid hair growth, not for cosmetic purposes

Category 3 (appointment clinically indicated within 365 days)

  • patchy hair loss e.g. alopecia areata involving less than 20% of scalp hair, not responsive to conventional therapies
  • increased hair shedding of uncertain aetiology greater than 3 months
  • increase hair thinning of uncertain aetiology
  • female pattern hair loss or telogen effluvium in severe cases if management is difficult

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Investigation prior to referral, please perform and collect underlying abnormalities as indicated for increased hair shedding and increased hair thinning/rapid hair growth:

  • complete blood examination (CBE)
  • electrolytes, urea, creatinine (EUC)
  • liver function test (LFT)
  • antinuclear antibody (ANA) and extractable nuclear antigen (ENA) and double stranded DNA (dsDNA) if ANA raised
  • iron studies
  • thyroid function test (TFT)
  • syphilis serology, if at risk
  • vitamin D
  • androgen studies, if increased hair thinning/rapid hair growth only

Additional information to assist triage categorisation

  • percentage of hair loss noted, total surface area, loss of % of ponytail
  • past medical conditions
  • up-to-date medication list
  • details of previous treatments, names, dosages, duration

Clinical management advice

The aim of the Hair Clinic is to provide a diagnostic service. Patients with female pattern hair loss or telogen effluvium will be returned to the care of the General Practitioner following diagnosis for ongoing management with guidelines provided.

In some circumstances, syphilis should be considered in the differential diagnosis. In the current syphilis epidemic there have been diverse presentations and syphilis has not always been recognised.

Patterned hair loss

Patients should be advised that ongoing treatment is required to maintain benefit, discontinuation of therapy will lead to hair returning to pre-treatment levels

  • topical Minoxidil 5% lotion/foam bd to crown of scalp
  • for women, consider anti-androgen therapy with spironolactone 50 to 100 mg orally, once daily, increase to 200mg daily if no benefit is apparent after 6 to 12 months or cyproterone acetate. Baseline Blood Pressure, EUC prior to spironolactone then repeat EUC every 3 months in women greater than 35 years of age.
  • for both men consider finasteride 1mg daily or dutasteride 0.5mg daily
  • oral Minoxidil can be added in, 0.5  to 2.5mg daily for women, 0.5 to 5mg daily for men

For alopecia areata

  • topical steroids (lotion) e.g. mometasone furoate lotion applied to the scalp daily to localised patches
  • Minoxidil 5% lotion can also be applied to the hairless areas twice daily

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.