Assessment of Referrals to a New Pediatric Dermatology Unit in Sarawak, Malaysia: First Year Insights

Abstract Background: Pediatric dermatology is a highly specialized branch of medicine that focuses on the diagnosis and management of skin, hair, and nail disorders in children. The first-ever pediatric dermatology unit in Sarawak was established in March 2023. This pilot study aims to analyze the demographics of patients, the spectrum of skin diseases, the source and outcome of referrals made in the 1 st year of this newly established service. Materials and Methods: This is a retrospective review on all direct referrals to the pediatric dermatology unit in Sarawak General Hospital, Kuching, Sarawak, Malaysia, over a period of 1 year (March 2023–March 2024). Data collected includes patients’ demographics, diagnosis classification, level of urgency, information of the referring centers, and the immediate management plan. Results: There are a total of 371 referrals made throughout the study period, with 53.1% males and 46.9% females. The mean age of patients was 3.15 years (range from day 1 of life to 17 years old). The most common conditions referred were infections (27.2%), atopic dermatitis (21.8%), and vascular anomalies (21%). The main source of referrals was from intra-hospital (41%), followed by government health clinics (36%) and district hospitals (22%). A vast majority are nonurgent referrals (96%), while urgent cases (4%) were dermatological emergencies and cases that require immediate hospital admissions. The outcome of most referrals was clinic review within 1 week (65%), while 18% were reviewed as inpatients and 17% were managed remotely with a given treatment plan. The majority of referrals within the hospital and nearby healthcare facilities received in-person specialist consultations, in contrast to referrals from district hospitals, in which a significant proportion had to be managed remotely (96.5% vs. 62.7%, P < 0.01). The latter situation can be attributed to distance and logistical difficulties. Although not ideal, this referral system is necessary to deliver pediatric dermatology services to the entire Sarawak, including rural district areas. Conclusion: This is a pilot study analyzing the referral patterns of the pediatric dermatology service in Malaysia. Findings of this study can help with manpower and financial planning of current and future pediatric dermatology services throughout the nation and the development of educational and training programs.