Experience with the dermatology inpatient hospital service for adults: Mayo Clinic, 2000-2010

Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India

BACKGROUND

Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions.

AIMS

We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India.

METHODS

This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017.

RESULTS

Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted.

LIMITATIONS

The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study.

CONCLUSION

This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.

Leiner's disease (erythroderma desquamativum): A review and approach to therapy

Leiner's disease (LD) is a rare and serious syndrome of infantile erythroderma of severe and progressive generalized seborrheic-like dermatitis, recalcitrant diarrhea, malabsorption and wasting, and recurrent local and systemic infections. The purpose of this study is to provide an updated review on management with a summarized review of available peer-reviewed articles on LD. The mechanisms underlying this disease process remain unclear. The diagnosis includes demonstration of deficient opsonic activity along with the clinical tetrad of erythroderma, persistent gastrointestinal disturbance, superimposed bacterial or candidal infection, and marked wasting. An important correlation between LD and defective yeast and Staphylococcus aureus opsonization has been established. For the familial form of LD, an association of either complement three deficiency or complement five dysfunction has been made. LD should be distinguished from other types of infantile erythroderma, including Omenn syndrome. Treatment includes fluid and nutrition replacement, antibiotics to control infection, and fresh-frozen plasma therapy. The prognosis is unclear; it depends on treatment. LD is a life-threatening condition that requires prompt identification and hospitalization. Affected infants who receive vigorous treatment not only have the prospect of surviving, but also generally lead a normal life after infancy.

Dermatology inpatient consultations in Latin America: 3-year experience in our University Hospital setting

BACKGROUND

Dermatology patients are mostly seen in outpatient clinics; however, there is a significant need for consultations within the hospital setting.

METHODS

Here we describe the hospital consultations received by the Dermatology Service during a 3-year period.

RESULTS

Most of the requested consultations came from the Internal Medicine Department and the surgical departments. The most common encountered dermatoses were drug eruptions and adnexal diseases, followed by viral dermatoses.

CONCLUSIONS

In hospital dermatology may pose a challenge for other clinicians; therefore, dermatologists should be adequately trained to confront a wide variety of clinical scenarios.

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.

Filling a critical practice gap: experience with a dermatology day treatment center at Mayo Clinic

BACKGROUND

Intensive treatment options are lacking for patients with severe skin disease recalcitrant to outpatient therapy. The availability of inpatient dermatology care has almost disappeared in many parts of the United States. One possible solution for this is a day treatment center for patients with severe dermatologic disease recalcitrant to outpatient therapy.

METHODS

Descriptive study based on retrospective medical record review of all patients attending the day hospital for treatment in 2010. We collected data on patient demographics, distribution of admission diagnosis, treatments used, and length of stay.

RESULTS

A total of 211 patients had 235 admissions. Mean age was 57.7 years (range 3.8-92.1 years). The most common indications for admission were dermatitis (139 admissions [59.2%]), psoriasis (58 [24.7%]), and mycosis fungoides (eight [3.4%]). The main treatment interventions were wet dressings (195 admissions [83.0%]) and Goeckerman treatment (38 [16.2%]). The median number of days of treatment was three (interquartile range, 2-5 days) for wet dressings and 22 days (interquartile range, 21-24 days) for Goeckerman therapy.

CONCLUSIONS

The dermatology day treatment center provided intensive skin-directed therapy and filled a critical practice gap in the management of our patients with severe widespread skin diseases recalcitrant to outpatient therapy. We propose that the dermatology day treatment center is a valuable model that could be considered by both private practitioners and academic centers in the United States as an important adjunct to fill the gap in availability of intensive topical treatments for patients with severe skin disease.

Infectious eczematoid dermatitis: a comprehensive review

Infectious eczematoid dermatitis (IED) is characterized by an acute eczematous eruption triggered by purulent discharge from a primary infected site. Alcohol consumption, cigarette smoking and occupations with higher incidences of contact dermatitis portend increased risk for IED. Staphylococcus aureus is the most commonly cultured microbe from affected skin, with Streptococcus species the second most. Patients are first evident with peripherally spreading vesicles and pustules radiating from an infected site. Older areas of involvement become crusty, scaly and erythematous. Diagnosis is clinical. Other eczematous rashes, including autoeczemitization and contact dermatitis, should be on the differential diagnosis list. The treatment centres on topical antibiotics and soaks. Prognosis has improved since the advent of antibiotics. However, cases with multiple relapses and poor response to therapy are still observed.