Inpatient dermatological consultations in a university hospital

Abstract

INTRODUCTION:Dermatology is primarily an outpatient specialty, but it also plays an important role in the care of inpatients.METHODS:We conducted a prospective study that recorded data from inpatient dermatology consultation request forms over a period of four months. The study evaluated 313 requests that led to 566 visits, 86 biopsies, 35 laboratory exams, 41 direct microscopic studies, 18 direct immunofluorescence analyses, 14 skin cultures and a few other exams.RESULTS:The most frequent requesting service was internal medicine (24%), followed by neurology (12%), cardiology (11%), infectious diseases and pediatrics (8% each) and psychiatry and general surgery (6% each). The most frequent diagnostic groups were infectious diseases (25%, divided into fungal infections (13%), bacterial infections (7%) and viral infections (5%)), eczemas (15%) and drug reactions (14%). To our knowledge, this is the first study to attempt to evaluate the impact of the consultations by asking multiple‐choice questions that were analyzed by the authors. In 31% of the cases, the consultation was considered extremely relevant because it aided in managing the disease that led to admission or treated a potentially severe dermatological disease. In 58% of the cases, the consultation was considered important because it facilitated diagnosis and/or treatment of a dermatological disease that was unrelated to the reason for admission.

Analysis of pediatric dermatology inpatient consultations in a pediatric teaching hospital

“…This high frequency of infections in inpatients were explained by the immunosuppression of some patients and the presentation of skin infections as a common reason for patient admission. 3,15,16 The cases of neonatal varicella, staphylococcal scalded skin syndrome, extensive bullous impetigo, congenital cutaneous candidiasis, cellulitis, necrotizing fasciitis, abscess which were the primary dermatological cases required hospitalization and regular monitoring both by the dermatologist and pediatrician in another study. Other skin infections were co-existing along with primary systemic complaints.…”

“…These reactions can be explained by the large amounts of drugs received by inpatients during hospitalization and dermatology consultation is helpful in identifying the most likely responsible medication. 5,16 Genodermatoses were the fourth most commonly diagnosed disease group in which epidermolysis bullosa was the most frequent one followed by ichtyoses probably due to frequent consanginous marriages. The disease group 'miscellaneous' came after the genodermatoses in frequency.…”

To study the relevance of inpatient dermatology referrals in a Teaching Hospital of North India

“…This might have occurred as many medical disorders are associated with dermatological manifestations which may serve as important clues for diagnosis of the underlying medical conditions. However, in some studies [11,14,15], neurology unit has accounted for a significant number of referrals after internal medicine. In an Indian study [3], from Secunderabad, surgery (29.8%) and internal medicine (29.7%) departments were responsible for more than half of the referrals to dermatologists.…”

Análisis de las interconsultas con dermatología pediátrica de pacientes hospitalizados en un hospital pediátrico universitario

“…La frecuencia elevada de infecciones en los pacientes hospitalizados se explica debido a la inmunosupresión de algunos pacientes y a la presentación de las infecciones cutáneas como motivo habitual de hospitalización. 3,15,16 Los casos de varicela neonatal, epidermólisis estafilocócica aguda, impétigo ampolloso extenso, candidiasis cutánea congénita, celulitis, fascitis necrosante y absceso que fueron los casos dermatológicos principales requirieron hospitalización y supervisión regular por parte de un dermatólogo y un pediatra en otro estudio. Se presentaron otras infecciones cutáneas junto con síntomas sistémicos principales.…”

“…Estas reacciones pueden explicarse por la gran cantidad de medicamentos que reciben los pacientes durante la hospitalización, y la interconsulta con dermatología sirve para identificar el medicamento que más probablemente sea el causante. 5,16 L a s g e n o d e r m a t o s i s f u e r o n e l c u a r t o grupo de enfermedades más diagnosticadas, dentro del cual la epidermólisis ampollosa fue la más frecuente, seguida por la ictiosis, tal vez debido a los matrimonios consanguíneos habituales. Al grupo de genodermatosis le siguió, en cuanto a la frecuencia, el grupo de enfermedades "misceláneas".…”