Should I schedule a prompt dermatology follow‑up per the original referral and also arrange an ENT evaluation for her bilateral ear fullness and pain, and what interim care should be provided?

Dermatology and ENT Referral Management

Schedule the dermatology follow-up as originally requested and arrange a prompt ENT evaluation for her bilateral ear fullness and pain, while providing interim symptomatic care for both conditions. 1

Dermatology Referral Follow-Up

When to Schedule

• Complete the original dermatology referral as planned, since the patient is requesting follow-up from an existing referral 1
• If the original referral indicated concerning features (color variation, nodules, symptoms, or specific location), ensure the appointment occurs promptly 1
• For routine dermatologic concerns without red-flag features, standard outpatient scheduling within a few weeks is appropriate 1

Documentation Requirements

• Ensure the referral includes clear indication for the visit, relevant clinical history, and any interim changes 2
• Photographic documentation of any skin lesions should be included if available to facilitate classification 1, 3

ENT Evaluation for Bilateral Ear Symptoms

Indications for ENT Referral

The patient's bilateral ear fullness with pain warrants ENT evaluation because:

• Ear pain, pruritus, discharge, sensation of clogged ears, or hearing loss are explicit indications for ENT referral 1
• Bilateral symptoms suggest potential cerumen impaction, Eustachian tube dysfunction, or other treatable causes requiring specialist assessment 1

Urgency of ENT Referral

• This is a non-urgent referral unless accompanied by:
  • Severe pain
  • Hearing loss
  • Fever or systemic symptoms
  • Discharge suggesting infection 1
• Schedule within 2-4 weeks for standard evaluation 1

Interim Care Pending Specialist Visits

For Ear Symptoms

• Assess for cerumen impaction by direct visualization of the external auditory canal 1
• Consider ceruminolytic ear drops (such as docusate sodium solution) if cerumen is visualized 1
• Avoid instrumentation if you are not trained in cerumen removal 1
• Do not prescribe topical corticosteroids for the ears without ENT evaluation, as they may worsen infection or mask diagnosis 1, 3

For Dermatologic Concerns

• If the patient has active skin symptoms while awaiting dermatology:
  • Apply bland, thick emollients (creams or ointments with minimal fragrances or preservatives) for chronic management 1
  • Low- to mid-potency topical corticosteroids twice daily may be used for acute eczematous flares if appropriate 1
  • Maintain basic skin care with gentle cleansers and moisturization 1, 4

Red-Flag Symptoms Requiring Urgent Action

Dermatologic Emergencies

Immediately escalate to same-day dermatology consultation if any of the following develop:

• Rash covering >30% body surface area 1, 3
• Any rash with mucosal involvement (oral, ocular, genital) 1, 3
• Blisters covering ≥1% body surface area 1, 3
• Skin pain resembling sunburn (excluding dermatomal distribution) 1, 3
• Fever, lymphadenopathy, or systemic symptoms accompanying a rash 3

ENT Emergencies

Arrange urgent ENT evaluation or emergency department visit if:

• Severe, uncontrolled pain develops 1
• Sudden hearing loss occurs 1
• Fever with ear pain suggests acute infection 1
• Facial nerve weakness or vertigo develops 1

Communication and Coordination

Referral Documentation

• Send clear, concise referral notes to both specialists including:
  • Chief complaint and duration
  • Relevant medical history
  • Current medications
  • Specific questions for the consultant 2, 5
• Ensure closed-loop communication by requesting consultation notes back to your office 2, 6

Patient Instructions

• Provide written information about both appointments 1
• Instruct the patient to contact your office if symptoms worsen before specialist visits 1
• Document all referrals in the patient's chart and inform all providers involved in the patient's care 1

Common Pitfalls to Avoid

• Do not delay ENT referral assuming ear symptoms will resolve spontaneously; persistent fullness and pain warrant evaluation 1
• Do not over-investigate isolated dermatologic concerns that are already being referred to dermatology; allow the specialist to direct workup 4
• Avoid starting systemic steroids for dermatologic conditions without specialist input, as this may mask serious diagnoses 1, 3
• Do not dismiss the patient's request for multiple referrals as inappropriate; bilateral ear symptoms represent a distinct clinical concern requiring separate specialist evaluation 1