Characterisation and diagnosis of ulcers in inpatient dermatology consultation services: A multi‐centre study

Abstract

Accurate and prompt diagnosis of skin ulcers is critical to optimise management; however, studies in hospitalised patients are limited. This retrospective review of dermatologic consultations included 272 inpatients with skin ulcers between July 2015 and July 2018 in four U.S. academic hospitals. The median age was 54 years and 45% were male. In 49.3% of the patients, skin ulcers were considered the primary reason for admission. Ulcers of 62% were chronic and 49.6% were located on the lower extremities. Pyoderma gangrenosum (17.3%), infection (12.5%), and exogenous causes (11.8%) were the leading aetiologies; 12% remained diagnostically inconclusive after consultation. Diagnostic agreements pre‐dermatology and post‐dermatology consult ranged from 0.104 (n = 77, 95% CI 0.051‐0.194) to 0.553 (n = 76, 95% CI 0.440‐0.659), indicating poor‐modest agreement. This study highlights the diagnostic complexity and relative incidences of skin ulcers in the inpatient setting.

Telemedicine for inpatient dermatology consultations in response to the COVID-19 pandemic

“…2 Hospital-based dermatology is also instrumental in the diagnosis and management of morbid conditions such as neutrophilic dermatoses, vasculitis, adverse reactions to chemotherapy, and other diseases that complicate and extend hospitalizations. 3 Inpatient dermatology services will continue to provide impactful care throughout the COVID-19 crisis with a particular need to help allocate scarce resources.…”

Inpatient Teledermatology Improves Diagnostic Accuracy and Management of Leg Ulcers in Hospitalized Patients

“…Of note, 42/59 (72%) patients had either in-person follow-up or biopsy confirmation of their diagnosis, while 22/59 (37.3%) had both in-person follow-up and pathologic confirmation. Notably, the biopsy recommendation among 69.1% of patients was higher than other studies where dermatologists recommended biopsies in 49.6% of inpatient general ulcers seen in-person, indicating the more frequent need for pathologic confirmation in teledermatology cases [ 5 ].…”

Neutrophilic Dermatoses: a Clinical Update

“…Recent US data on the inpatient burden of PG identified female sex, black race/ethnicity, and multiple chronic conditions as predictors of PG-associated hospitalizations in both adults fand children [ 80 ••, 81 ]. Moreover, PG was the leading etiology of ulcers seen by US inpatient consultative dermatology services [ 82 ].…”