Dermatology

The main base of the Department is at Ninewells Hospital, Dundee. This is predominantly an outpatient department which provides general and specialist clinics, phototherapy/PUVA, photodynamic therapy, skin surgery, laser therapy and a nurse run outpatient treatment centre.

Peripheral clinics are held at Perth, Stracathro, Arbroath, St Andrews and Cupar and outpatient therapy centres including phototherapy and PUVA are available at Perth, Stracathro and St Andrews. UVB phototherapy is also available at Arbroath Infirmary and in community hospitals in Crieff and Pitlochry.

Located within the Ninewells department is the National Referral Centre for Photobiology and Porphyria and the Dermatology Cancer Centre, which provides state-of-the-art facilities for investigation and treatment of skin cancer, including the North of Scotland Cancer Network (NOSCAN) Macmillan Mohs service.

Please view GP guidance on derm photography when attaching photos to SCI referrals (ensure patient consent and avoid if lesion/rash is on a sensitive area of the body such as genitals).

Emergency referrals via on-call derm page through switchboard 
Dermatological emergencies in adults and children:
• acute erythroderma (>90% skin affected)
• acute generalised pustular reactions
• acute desquamating and blistering reactions
• acute severe drug reactions with systemic symptoms
• acute small vessel vasculitis
• suspected eczema herpeticum

Urgent referrals via SCI-Gateway:
Skin lesions
• Suspicious pigmented lesions
• Suspected Squamous Cell carcinoma
• High-risk Basal Cell Carcinoma (e.g. high-risk site, immunosuppressed patient)

Inflammatory diseases:
• Acne fulminans(severe acne with systemic upset)
• Acute drug eruptions
• Severe eczema, psoriasis or other rash

Routine referrals via SCI-Gateway:
Click on the following links for NHS Scotland's Dermatology Patient Pathways, with guidance on management and referral of the following conditions.
(Tayside formulary to be referenced for medication choices where relevant).
NHS Tayside specific guidance highlighted where available:

• Acne. (Acne vulgaris PCDS also has a lot of useful information)
• Actinic Keratosis / Bowens disease
• Alopecia
• Benign lesions - skin tags, warts, moles, dermatofibroma
• Benign lesions - lipoma, cyst, haemangioma, xanthelasma, comedones, granuloma
• Eczema - atopic (adults) - atopic (paediatric) - hand and foot
• Fungal nail infection
• Hidradenitis Tayside treatment guidance  (please note this is an intranet page only)
• Molluscum contagiosum
• Non-melanoma skin cancer (low-risk BCC)
• Pruritus
• Psoriasis
• Rosacea - Tayside Rosacea treatment guidance
• Scabies
• Seborrhoeic dermatitis
• Urticaria
• Viral warts

Also suitable for referral:
Severe nail dystrophy
Undiagnosed troublesome rashes
Suspicion of contact dermatitis (when clinically significant symptoms)

Photosensitivity and request for Photodiagnostic investigations:
Patients with suspected abnormal skin reactions to light (photosensitivity) should be referred initially through the general dermatology referral pathways for initial assessment. If light testing (photodiagnostic) investigations are then thought to be needed, the patient will be referred on to the tertiary national photodiagnostic service (Scottish Photobiology Service; SPS), based at Ninewells, for further investigation.

For laser therapy:
Direct referral (with accompanying photographs where appropriate) can be made for:

• Severe hirsutism in association with endocrine disorder (dark hair, faces only)
• Severe acne scarring or severe rhinophyma
• Significant vascular lesions (e.g. port wine stain, hereditary haemorrhagic telangiectasia, bleeding benign lesions)

Benign lesions: Only refer if diagnostic doubt, significantly symptomatic or causing functional impairment.
e.g. Skin Tags, Seborrhoeic keratoses, Benign Naevi (moles), Dermatofibroma, Lipoma, Epidermal (sebaceous) cyst, Spider haemangioma.

Routine, urgent and advice referral via SCI-Gateway with attached photos if possible.

For URGENT telephone advice or in-person review, call Ninewells switchboard on 01382 660111 and page on-call dermatology registrar.