Prevalence of cutaneous findings in hospitalized medical patients

The Evaluation and Management of Macronutrient Deficiency Dermatoses

In industrialized countries, nutritional dermatoses are likely underdiagnosed and result in increased disease morbidity and utilization of hospital resources. These findings underscore the need for physicians to be able to correctly identify these deficiencies. Nutritional dermatoses may be split into micronutrient deficiencies and macronutrient deficiencies. This article is intended to serve as a supplement to a two-part review of micronutrient deficiency dermatoses and highlights cutaneous findings in patients with protein-energy malnutrition and essential fatty acid deficiency. This article reviews the evaluation, cutaneous manifestations, and management of macronutrient deficiencies.

Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

BACKGROUND/AIMS

The spectrum of dermatological emergencies is broad. Only a few studies have assessed the profile of dermatological conditions resulting in an emergency visit in a referral hospital. We sought to assess the conditions prompting an urgent dermatological visit and to compare the diagnoses with those made during the regular scheduled encounters.

METHODS

We performed a cross-sectional study of all patients with a cutaneous problem attending our emergency consultation during a 7-month period. The study variables were gender, age, duration of symptoms, diagnosis, need for hospitalization and/or follow-up. We further evaluated patients attending scheduled visits to compare the demographic characteristics and diagnoses between the two groups.

RESULTS

Six hundred fifty-two consecutive patients with an urgent dermatological consultation were included. Three hundred sixty (55.2%) were women and 292 (44.8%) were men. Infectious diseases (32.8%) as well as various forms of eczema (24.8%) constituted the most frequent causes for an emergency visit. Approximately 40% of emergency visits took place more than 1 week after the development of the cutaneous manifestations. The most frequent disorders seen in the 1,738 control patients included benign melanocytic and nonmelanocytic tumors (27.2%) and malignant skin lesions (11.5%).

CONCLUSIONS

Our study indicates that the dermatological diagnoses in the emergency visits significantly differ from those of the routinely scheduled appointments. In a significant portion of patients, the use of an emergency consultation was not justified. This study provides support to the idea that a specific training is required to manage dermatological emergencies and that efforts should be made to reduce unjustified emergency visit use.

Inpatient Consultative Dermatology

Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information.

Patterns of inpatient dermatology referral and predictors of diagnostic accuracy in non-dermatologists in a Northern District hospital in Singapore

BACKGROUND

A wide range of dermatological conditions is often encountered in the inpatient setting. Many non-dermatologists experience difficulty in their diagnosis, and referral to a dermatologist is often warranted. In our local setting, this is made through a formal written referral letter, which is usually drafted by the junior doctor on the team.

OBJECTIVES

This study was conducted to characterize patterns of inpatient dermatology referral and to investigate whether predictors of diagnostic concordance between the referring non-dermatologist and the reviewing dermatologist can be identified.

METHODS

A total of 168 inpatient dermatology referrals made between June and September 2013 at a Northern District hospital in Singapore were identified and reviewed. Collated variables were broadly divided into: (i) patient demographic details; (ii) the referring details of non-dermatologists; and (iii) the response details of reviewing dermatologists.

RESULTS

No predictors of diagnostic concordance could be identified statistically. A total of 90.5% (n = 152) of referrals were made for both diagnostic and management purposes, whereas 9.5% (n = 16) of referrals were made purely for management purposes. Of the 152 diagnostic and management referrals, a preliminary diagnosis was reflected in 69.1% (n = 105). In 47.6% of all referrals (n = 80), more than one dermatological condition was identified. The fungal smear was the most commonly requested ancillary investigation (22.6%, n = 38/168). Cutaneous skin infections (32.0%, n = 85/266) and endogenous eczema (32.0%, n = 85/266) were by far the two most commonly identified dermatological conditions in our local cohort of patients.

CONCLUSIONS

The need for a dedicated inpatient dermatology service is reinforced. However, targeted education may be employed to facilitate the referral process.

Teaching effects of dermatological consultations on nondermatologists in the field of internal medicine. A study of 1290 inpatients

BACKGROUND

Scarce data exist concerning dermatological consultations within departments of internal medicine. To date, no survey has been carried out in Switzerland to elucidate this issue. The aim of this study was to analyze the spectrum of skin diseases internists are confronted with and to study their diagnostic accuracy in cutaneous diseases. In addition, we wanted to evaluate the motivation for dermatologists to cooperate closely with internists.

PATIENTS AND METHODS

The study included patients with dermatological problems treated at the Department of Internal Medicine at the Kantonsspital Aarau, Switzerland. All patients had been referred to the Department of Dermatology for examination between 1999 and 2001. Patient data were analyzed demographically, by referral modus, diagnoses and therapy. To evaluate the knowledge of internists and dermatologists in cutaneous medicine, 15 clinical slides of common dermatoses with a patient history were shown and asked for diagnostic suggestions to 32 internists of the Kantonsspital Aarau and to 13 dermatologists of the University Hospital Basel, Switzerland.

RESULTS

1290 patients were referred to the Department of Dermatology. 1737 dermatological diagnoses were made including 348 different dermatoses. Eczema was the single most common diagnosis (12.6%), followed by actinic and bowenoid precancerosis (6.2%), drug eruption (4.2%), verrucae (4%) and mycosis (3.8%). The top ten diagnoses accounted for 41.7% of all skin-related diagnoses. Infection-related dermatoses were most common (20.5%) followed by different types of eczema (12.6%), malignant cutaneous tumors and malignant visceral conditions (11.2%). Local therapy was prescribed in 64.2% and systemic therapy in 22.6% of the patients. 15.9% did not receive specific therapy because the consultation request was only a diagnostic one. 146 skin biopsies were performed (11.3%). Systemic diseases with cutaneous manifestations accounted for 15.7%. In general, these conditions were not commonly seen by dermatologists in daily practice. The internists recognized 51.1% of the cutaneous manifestations during examination and 49% when presented with slides.

CONCLUSIONS

Internists are confronted with a different spectrum of cutaneous diseases compared with dermatologists. Due to the broad spectrum of skin diseases, it is a challenging task for internists to recognize dermatoses. Our study elucidates that patients, internists and dermatologists may profit from a close cooperation.

Inpatient dermatology. A prescription for survival

Currently, only a minority of dermatologists participate in the primary hospital care of patients with severe skin disease. However, an opportunity exists to alter this course. We believe the current course is a detriment to our specialty, and as a specialists we should provide the care for the full spectrum of dermatologic diseases. Moreover, by not delivering complete dermatology care, our specialty also stands to lose respect from both our patients and peers. Our experience at UM suggests that the creation of a cadre of dermatology hospitalists at selected academic medical centers would allow improved patient hospital care, education, and research.

Inpatient dermatology consultation

Common dermatologic conditions and skin signs of systemic disease are routinely present in hospitalized patients. Rapid detection and identification of these changes can have a significant impact on the patient's hospital course. Inpatient dermatology consultation can improve diagnostic accuracy, efficiency, and treatment of hospitalized patients with cutaneous findings. This article discusses the clinical aspects of inpatient dermatology consultation and the features of effective consultation.

Prevalence of cutaneous findings in hospitalized pediatric patients

Cutaneous findings can be useful in establishing the diagnosis and treatment of hospitalized patients. Observation and identification of cutaneous abnormalities can improve the accuracy of diagnosis and result in improved patient care. We set out to determine the prevalence of cutaneous abnormalities in hospitalized pediatric patients in a hospital and how often these findings were noted and properly diagnosed by the admitting team of physicians. Children with medical problems admitted to Kosair Children's Hospital during the month of January 1995 were randomly selected for a skin examination, which was performed within 24 to 28 hours of admission. Parental consent was required prior to admission into the study. Of 117 patients offered participation, 110 accepted. Physical findings were noted and in addition the completeness of charting by the admitting physician and the relationship of any cutaneous findings to admitting diagnosis were noted. One hundred five of the 110 patients (95%) had cutaneous findings consisting of either a "rash" or a "congenital lesion." Fifty-one had more than one cutaneous finding noted on examination. Dermatitis was the most common diagnosis made, followed by pigmented lesions and congenital vascular malformations of all types. In 35 of the 105 patients with a dermatologic diagnosis, the dermatologic diagnosis related directly to the admitting diagnosis. In only 22 of these 35 (63%) was the cutaneous involvement noted by the admitting physician. In 9 of the 110 cases (8%), the findings on dermatologic examination altered the primary diagnosis and/or treatment. Cutaneous findings are very common in the hospitalized pediatric patient. The diagnosis, charting, and treatment of dermatologic conditions by the primary pediatric team were often incomplete, although an expert cutaneous examination can be critical to patient care.