Skin rash (acute and chronic)

Severe nodulocystic/conglobate acne or scarring or major psychological impact → refer; acne fulminans (systemic upset, u

Induration, tenderness, ulceration or rapid growth in an actinic keratosis → exclude invasive SCC (biopsy)

Eczema herpeticum — monomorphic punched-out painful erosions, unwell/febrile (HSV superinfection): same-day, oral/IV aci

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures → do not delay antibiotics; signs of raised ICP

Development of a nodule, ulceration, or rapid growth within the plaque → progression to invasive SCC (biopsy)

Severe occupational/hand disease threatening work; airborne or widespread facial involvement

Recurrent/extensive candidiasis → screen for diabetes or immunosuppression

Tinea capitis needs ORAL therapy (topical does not reach the hair shaft); a kerion (boggy inflamed mass) needs prompt tr

Atypical, rapidly growing, bleeding or non-healing "wart" in an adult → consider SCC (biopsy); immunosuppression → numer

Haemodynamic instability, hypothermia, high-output failure, secondary sepsis — admit

Meningitis/encephalitis features, focal/prolonged seizure, age <6 months or >6 years, not returning to normal

Venous thromboembolism risk

Severe abdominal pain (intussusception), GI bleeding, hypertension or significant proteinuria (renal involvement)

Strangulation (tender, irreducible, red, painful lump + obstruction/peritonism) → emergency surgery

Eye redness, pain, photophobia or reduced vision, or Hutchinson sign → ophthalmology assessment for ocular involvement

AIDS-defining illness, very low CD4, seroconversion illness, needle-stick/exposure (PEP within 72h)

SPLENOMEGALY → risk of splenic rupture (avoid contact sport for ~4–6 weeks); rarely airway compromise from massive tonsi

Very high bile acids (stillbirth risk); features of pre-eclampsia/HELLP or acute fatty liver of pregnancy (a different e

Coronary artery aneurysms — the feared complication; incomplete Kawasaki in infants

Erosive oral or genital lichen planus has a small risk of squamous cell carcinoma — long-term monitoring

Complications: otitis media, pneumonia, encephalitis, (late) SSPE; immunocompromised/pregnant

Measles in pregnancy/immunosuppressed, or with encephalitis/pneumonia → severe; rubella exposure in a pregnant woman → u

Numerous, large or facial mollusca in an adult → test for HIV/immunosuppression

Mesothelioma (asbestos exposure + pleural effusion/chest pain/pleural thickening) → urgent investigation; it is compensa

Lesions on the palms and soles, or absence of a herald patch → exclude secondary syphilis

Underlying malignancy (especially with dermatomyositis) → age-appropriate cancer screen

Acute risk of self-harm/suicide; dissociative flashbacks

Erythrodermic or generalised pustular psoriasis = dermatological emergency (same-day referral, fluid/temperature comprom

Ocular rosacea with eye pain or visual disturbance (keratitis) → ophthalmology; disfiguring rhinophyma

Febrile convulsion; a toxic/unwell child or non-blanching rash (exclude meningococcal sepsis)