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INTRODUCTIONDermatology practice takes place mainly in the outpatient setting. However, several inpatient referrals are made to dermatology departments by other specialties on a daily basis for proper patient management in the hospital settings [1]. The knowledge of dermatology among non-dermatologists is believed to be very poor [2][3][4][5]. Patients admitted to non-dermatology units may often have numerous skin lesions besides the systemic disease for which they are hospitalized [5,6]. The dermatoses may be associated with significant morbidity and at times mortality [7]. These inpatients with dermatoses often require expert dermatology consultation. The interdepartmental referral not only helps in patient care but also improves the diagnostic acumen and clinical knowledge of the clinician [6,[7][8][9][10][11]. MATERIALS AND METHODSThis retrospective observational study, after obtaining approval from Institutional Ethics Committee, was carried out at tertiary hospital in North India assessing data over a period of 2 years. The Department of Dermatology at the hospital is responsible for all dermatological consultations for inpatients.The data thus obtained has been statistically analyzed with respect to patient demography, frequency of referrals made by different specialties, causes of referrals (presumptive diagnoses made by non dermatologists), diagnostic accuracy of referring departments by comparing with the final dermatological diagnoses made by senior faculty members as the gold standard, and impact of dermatology consultations on the management. ABSTRACTBackground: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other Departments and impact of dermatology consultation on patient management. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of North India during a two year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment. General medicine requested the maximum number of referrals, skin rash being the most common cause for referral. Accurate diagnosis on referrals was provided by only 25.23 % of non dermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of non dermatologists enabling them to recognize and treat common dermatoses.

En coup de sabre is a rare subtype of morphea. Only a few bilateral cases have been reported to date. We report a case of a 12‐year‐old male child with two linear brownish depressed asymptomatic lesions over the forehead with hair loss on the scalp. After thorough clinical, ultrasonography and brain imaging, a diagnosis of bilateral en coup de sabre morphea was made and the patient was treated with oral steroids and weekly methotrexate.

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Pyoderma gangrenosum (PG) is a rare neutrophilic disorder with an incidence rate of 3–10 cases per million per year, characterized by classically painful and aseptic ulcers, which may be associated with underlying systemic diseases. The pathergy reaction is seen in one-fourth of patients with PG. Accurate and timely diagnosis is crucial, as PG is known for its rapid progression. The management of PG is challenging and depends on its severity and rate of progression. An underlying systemic involvement should be sought even in spite of no symptoms. Herein, we report a case of giant pyoderma gangrenosum involving almost the entire left buttock with exceptionally raised c-ANCA levels, but no underlying systemic abnormality. The patient reported intense pain, rapid progression of the ulcers, an inability to perform daily activities, was significantly morbid and pathergy-positive. Aggressive and early management is required in cases such as this. A dramatic response was achieved with a combination of cyclosporine, dapsone, and methylprednisolone pulses.

Cutaneous botryomycosis is a chronic focal infection characterised by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus and occasionally Pseudomonas, Escherichia coli, Proteus, Streptococcus, etc. Early diagnosis and treatment with specific antibiotics alongwith surgical debridement is recommended. Cutaneous metastatic tuberculous abscess and scrofuloderma also presents as subcutaneous swellings and multiple discharging sinuses. A twenty two year old female patient presented with multiple erythematous subcutaneous lesions over lower back, buttocks and bilateral inguinal region, most of which were discharging purulent material since two years. This case is being reported because of the clinical dilemma it poses to the dermatologists.

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