Dermatology Consultation Communication Letter
Created by
Fiona Campbell
Specialty
Dermatologist
Last edited
10/20/2026
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About this template
A reusable letter structure for documenting dermatology diagnoses, relevant history, examination findings, clinical summary, management, GP actions, and follow-up. It supports clear communication with other healthcare professionals while capturing the information needed for coordinated patient care.
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Diagnosis
- Morbilliform drug eruption secondary to lamotrigine (Lamictal®), CTCAE Grade 2
Background
- 34-year-old female referred urgently by Neurology following new-onset widespread rash 14 days after commencing lamotrigine for focal epilepsy.
Dear colleague,
It was a pleasure to meet with Sarah Jenkins in clinic today.
History
- Symmetrical erythematous maculopapular eruption started on the trunk 3 days ago, progressing rapidly to proximal limbs.
- Associated with moderate pruritus; no skin pain or blistering.
- Denies systemic symptoms, fever, ocular grittiness, or oral/genital ulceration.
- Lamotrigine was withheld yesterday as per Neurology telephone advice.
Past medical history: Focal epilepsy, migraine without aura, mild asthma.
Medication history: Lamotrigine (Lamictal®) 25 mg PO OD (stopped), sumatriptan (Imigran®) 50 mg PO PRN, salbutamol (Ventolin®) 100 mcg INH PRN, NKDA.
Family history: Maternal psoriasis, no family history of severe cutaneous adverse reactions (SCARs).
Social History and Impact on Life
- Works as a primary school teacher; lives with her partner.
- Sleep significantly disrupted by pruritus over the last 48 hours, resulting in work absence today.
Examination
- Vitals: Temp 36.7 °C, HR 74 bpm, BP 118/76 mmHg.
- General: Alert, systemically well, no facial oedema.
- Cutaneous: Florid, blanching, erythematous maculopapular rash coalescing into plaques across the chest, back, and proximal upper and lower limbs (~35 % BSA).
- Negatives: Nikolsky sign negative. No vesicles, bullae, pustules, or targetoid lesions.
- Mucosae/Lymphatics: Oral, ocular, and genital mucosae completely spared. No palpable cervical, axillary, or inguinal lymphadenopathy.
Summary
- 34-year-old female presenting with an uncomplicated morbilliform drug eruption 2 weeks after initiating lamotrigine. There are no clinical red flags for DRESS or SJS/TEN at present.
Management Plan
- Permanently discontinue lamotrigine; record as a drug allergy in clinical records.
- Baseline bloods taken today (FBC, U&E, LFTs, CRP) to exclude subclinical internal organ involvement/eosinophilia.
- Commenced mometasone furoate (Elocon®) 0.1 % ointment TOP OD to affected areas on trunk and limbs for 10 days.
- Commenced fexofenadine (Telfast®) 180 mg PO OD for pruritus, plus regular emollient (epimax ointment (Epimax®) TOP QID).
- Counselled on SCAR red flags (fever, mucosal ulceration, skin pain, blistering) with strict instructions to attend A&E immediately if these develop.
GP action: Please update patient allergy record to include lamotrigine (morbilliform rash) and issue repeat prescriptions for epimax ointment 500 g if required. Liaise with Neurology regarding an alternative antiepileptic agent (copied to this letter).
Follow Up
Telephone follow-up in 48 hours to review blood results and assess rash progression. Routine face-to-face review in Dermatology clinic in 4 weeks, or sooner via our rapid-access pathway if symptoms worsen.
How to use this template
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