Dermatologic emergencies

The Role of Bloodletting and Cupping in Severe Acute Urticaria and Angioedema as Skin Emergencies in Persian Medicine

Objectives

Some dermatological diseases can be life-threatening. Urticaria and angioedema are common reasons for patients to seek treatment at an emergency department. Severe, generalized urticaria and angioedema can endanger patients’ lives by involving the airways and causing anaphylactic shock. The humor-based Persian Medicine (PM) concepts of Shara and Mashara, referring to two kinds of skin lesions, have similarities to urticaria and angioedema, respectively. This article aims to provide scientific evidence regarding the application of PM as an early intervention strategy in the emergency management of urticaria and angioedema.

Methods

This was a narrative review of PM studies identified by searching medical databases using search terms related to these diseases, as well as risk-associated keywords such as “fatal”, “death”, “life-threatening”, “emergency”, “cupping”, and “bloodletting”. Data were then compared, interpreted, and analyzed.

Results

PM scholars consider the human body as a unified whole and believe in an inner power (Nature) which stems from the body. When the presence of excessive hot substances cause an imbalance of bodily humors, Nature directs their heated vapors sharply toward the skin, thus causing Shara and Mashara. If there is a high risk of inflammation spreading to vital organs under severe conditions, urgent manual interventions are crucial.

Conclusion

In serious conditions of urticaria and angioedema, Fasd or bloodletting and Hijama can be effective in speeding up the control of lesions and reducing morbidity and mortality. Consequently, the development of integrated Persian and conventional medicines may provide new therapeutic pathways for skin emergencies.

Resources spent on dermatological emergency patients: A twelve-month prospective data collection from Germany

BACKGROUND AND OBJECTIVES

Rising numbers of patients consulting emergency units are associated with an increased demand for material and personnel. In order to better quantify these resources, we performed an analysis of diagnostic procedures, treatment types, and the quantity and educational level of staff involved in emergency consultations.

PATIENTS AND METHODS

The study was conducted as a prospective single-center survey over twelve months in the dermatology unit of a Germany university hospital. 3155 consultations were included by consecutive sampling.

RESULTS

Diagnostic tests (e.g. microbiological swab, blood testing, punch biopsy) were performed in 29 % of all consultations. Physicians prescribed treatment in 70 % of cases, with steroids and antihistamines being the most frequent topical and systemic treatment, respectively. Each patient was seen by at least one physician and a nurse, and in 25 % of cases an additional physician was involved. Less than thirty minutes was required for the consultation in the vast majority of cases. On average, emergency consultations required two hours per day of the treating physician's time, not including the time of other involved staff such as nurses and laboratory technicians.

CONCLUSIONS

This study demonstrates the extent of resources involved in the treatment of dermatological emergency consultations.