Inpatient Dermatology Research Articles

Inpatient and Tertiary Consultations in Teledermatology

Inpatient and tertiary teledermatology have significant potential to increase access to timely, high-quality, specialized dermatology care. Early studies on inpatient teledermatology suggest that it is reliable and can provide assistance with both triage and management decisions, making it a potentially valuable adjunct to increase access to inpatient dermatology care. Initial studies on tertiary teledermatology suggest that it is a popular modality of care, both formally and informally, and that it can reduce the need for referrals to tertiary care centers. However, the development of successful formal tertiary teledermatology networks has been challenging, especially when informal tertiary teledermatology networks are already available. Given the limited number of studies on both of these modalities, further research is needed to define their impact on clinical outcomes and the cost of care, as well as to explore solutions to potential economic, legal, and technological challenges that may limit their application.

The quality of dermatology consultation documentation in discharge summaries: a retrospective analysis.

IntroductionGood quality documentation of dermatology consults in discharge summaries allows diagnostic and therapeutic plans to be communicated to other health professionals and ensures that appropriate governmental funds are provided to dermatology departments.MethodsA retrospective analysis was performed of all dermatology consults seen in 2013 at a public tertiary hospital in Sydney, Australia.ResultsTwo hundred nineteen discharge summaries related to inpatient dermatology consultations were analysed; 80.6% of dermatology consults, 72.2% of skin biopsies, and 57.6% of diagnoses were duly included in the discharge summaries; 82.5% of the discharge summaries were completed before the discharge. The accuracy rate of diagnosis documentation was 54.5% and was correlated with clear dermatology team documentation, the use of a problems list, infectious skin diseases and junior medical staff authorship.ConclusionThis study highlights the need for improvement in dermatology consult documentation in discharge summaries. It suggests the use of a problems list in discharge summaries, clarity in dermatology teams’ documentations, and postdischarge follow-up.

Inpatient Dermatology: Characteristics of Patients and Admissions in a Tertiary Level Hospital in Eastern India.

Introduction:Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers.Aims and Objectives:To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India.Materials and Methods:We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay.Results and Analysis:A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27%) were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33%) and infective disorders (73 patients, 19.47%). Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2%) improved after hospitalization; while 29 (7.73%) patients died from their illness. About 133 patients (35.64%) required referral services during their stay, while 8 patients (2.13%) were transferred to other departments for suitable management.Conclusion:Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

Analysis of Dermatologic Diseases in Neurosurgical In-Patients: A Retrospective Study of 463 Cases

BackgroundBoth the skin and the neurologic system are derived from the ectoderm during embryogenesis, and thus patients with neurologic disorders may have accompanying dermatologic diseases. For example, seborrheic dermatitis is more frequently observed in patients with Parkinsonism and other neurologic disorders. To date, however, there has been limited review on dermatologic diseases in neurosurgical in-patients.ObjectiveThe purpose of this study was to characterize dermatological problems encountered in a neurosurgery unit and to compare these data to previous reports of in-patient dermatologic consultations.Methods A retrospective review was conducted over all in-patient dermatology consultations from the neurosurgery unit during a 3-year period.ResultsOf 2,770 dermatology consultations, 463 (16.7%) came from the department of neurosurgery. The most frequent age group was the 6th decade of life, and the ratio of men to women was 1.07. Consults were most frequently placed from patients with intracranial hemorrhage (23.8%). Eczema/dermatitis (36.5%; n=204) and cutaneous infections (27.0%; n=151) accounted for more than half of all dermatological consultations, followed by cutaneous adverse drug reactions (11.8%; n=66). Additionally, seborrheic dermatitis was significantly more frequent (p=0.048, odds ratio=1.96) in patients with intracranial hemorrhage.ConclusionThis study characterizes the distribution of skin disorders in patients admitted to the neurosurgery service based on the consultations that have been made for dermatologic evaluation. Collaboration between the neurosurgeons and dermatologists may improve the quality of patient care and help to better predict the occurrence of these conditions.

Pattern of Inpatient Dermatology Consultations in a Tertiary Care Centre from Northern India.

The importance of dermatology inpatient consultation is of significant importance yet is not well documented. To retrospectively analyse the spectrum of dermatology inpatient consultations from the various departments and to document the most commonly occurring dermatological disorders from each speciality. This study was done in an 800 bedded premier teaching hospital in Ludhiana, Punjab, North Western India. It was an audit of inpatient referrals to the dermatology department from January 2014 to August 2014. We analysed the spectrum of dermatological disorders in relation to the various specialities, demographic profile and age groups. The data was entered in Microsoft Excel and analysed using SPSS Version 21. Descriptive statistics, frequency and proportions were used. Of the 559 in-patients, 60% were males. The majority of the patients belonged to age group 51-60 years (25.9%). The departments most commonly requesting for dermatology consultations were Medicine (27.7%), Neurology (9.7%), Cardiology (8.8%), Urology (7%), Haematology (6.4%), Nephrology (6.1%), Intensive Care Unit (ICU) (5.4%), General Surgery (5.2%), Orthopaedics (5%), Gynaecology and Neurosurgery (2.9%) and Paediatrics (2.7%). The commonest dermatological diagnoses for which consultations were sought were eczematous dermatitis (12.9%), superficial dermatophytosis (12.3%), drug reactions (8.9%) and viral skin infections (8.5%). Dermatology consultations offer a significant role in diagnosis and management of the in-patients from various clinical speciality departments. There is a significant need of inter-departmental dermatology consultations which help to decrease morbidity and improve the quality of the patient's hospital stay. Knowledge about the pattern of dermatoses in the inpatients can help the primary clinician to recognize when to seek dermatology consultation on a priority basis.

Teledermatology as a means to improve access to inpatient dermatology care

Many hospitals have limited inpatient dermatology consultation access. Most dermatologists are outpatient-based and may find the distance and time to complete inpatient consultations prohibitive. Teledermatology may improve access to inpatient dermatology care by reducing barriers of distance and time. We conducted a prospective two-phase pilot study at two academic hospitals comparing time needed to complete inpatient consultations after resident dermatologists initially evaluated patients, called average handling time (AHT), and time needed to respond to the primary team, called time to response (TTR), with and without teledermatology with surveys to capture changes in dermatologist opinion on teledermatology. Teledermatology was only used in the study phase, and patients were seen in-person in both study phases. Teledermatology alone sufficiently answered consultations in 10 of 25 study consultations. The mean AHT in the study phase (sAHT) was 26.9 min compared to the baseline phase (bAHT) of 43.5 min, a 16.6 min reduction (p = 0.004). The 10 study cases where teledermatology alone was sufficient had mean study TTR (sTTR) of 273.3 min compared to a baseline TTR (bTTR) of 405.7 min, a 132.4 min reduction (p = 0.032). Teledermatology reduces the time required for an attending dermatologist to respond and the time required for a primary team to receive a response for an inpatient dermatology consultation in a subset of cases. These findings suggest teledermatology can be used as a tool to improve access to inpatient dermatology care.

Inpatient Treatment for Severe Nonsurgical Dermatological Disorders: Prevalence, Care Infrastructure and Reimbursement in Switzerland

Background: Since 2012, Swiss inpatient dermatology is funded through a flat rate payment system based on diagnosis-related groups (DRGs). Objective: To analyze the reimbursement of nonsurgically treated severe disorders of the skin under the system called SwissDRG. Methods: Three retrospective, cross-sectional cohort studies were performed. Data sets were received from the Swiss Federal Office of Statistics (1,285,685 retained records), the five Swiss university hospitals (370,964 retained records) and our center (72,211 retained records). Results: Cases accounted for 0.04% of all hospitalizations nationwide, with 43.7% treated at university hospitals. Treatment at university hospitals produced a mean loss of USD 3,711 per case. Lyell syndrome cases were especially underfunded (mean loss USD 31,906). Extra-county admissions and direct referrals were significant predictors of total inpatient costs (p = 0.019 and p < 0.001, respectively). Conclusions: We suggest grouping Lyell syndrome cases into burn DRGs and evaluating extra-county admissions and direct inpatient referrals as DRG split criteria.

Patterns of inpatient dermatology referral and predictors of diagnostic accuracy in non-dermatologists in a Northern District hospital in Singapore.

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. 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. 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. 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. The need for a dedicated inpatient dermatology service is reinforced. However, targeted education may be employed to facilitate the referral process.

Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis

Given its nonspecific physical examination findings, accurately distinguishing cellulitis from a cellulitis mimicker (pseudocellulitis) is challenging. We sought to investigate the national incidence of cellulitis misdiagnosis among inpatients. We conducted a retrospective review of inpatient dermatology consultations at Massachusetts General Hospital, University of Alabama at Birmingham Medical Center, University of California Los Angeles Medical Center, and University of California San Francisco Medical Center in 2008. All consults requested for the evaluation of cellulitis were included. The primary outcomes were determining the incidence of cellulitis misdiagnosis, evaluating the prevalence of associated risk factors, and identifying common pseudocellulitides. Of the 1430 inpatient dermatology consultations conducted in 2008, 74 (5.17%) were requested for the evaluation of cellulitis. In all, 55 (74.32%) patients evaluated for cellulitis were given a diagnosis of pseudocellulitis. There was no statistically significant difference in the rate of misdiagnosis across institutions (P= .12). Patient demographics and associated risk factor prevalence did not statistically vary in patients given a diagnosis of cellulitis versus those with pseudocellulitis (P > .05). This study was unable to evaluate all patients admitted with cellulitis and was conducted at tertiary care centers, which may affect the generalizability of the results. Cellulitis is commonly misdiagnosed in the inpatient setting. Involving dermatologists may improve diagnostic accuracy and decrease unnecessary antibiotic use.

Uptake and impact of a clinical diagnostic decision support tool at an academic medical center.

Use of differential diagnosis (DDX) generators may reduce the incidence of misdiagnosis-related harm, but there is a paucity of research examining the use and impact of such systems in real-world settings. In September 2012, the DDX generator VisualDx was made available across our entire academic healthcare system. We examined the use of VisualDx by month for the 18 months following its introduction. In addition, we compared the number of inpatient dermatology consults requested per month at the flagship hospital of our healthcare system for the 12 months before versus 18 months after VisualDx introduction. Across our entire academic healthcare system, there were a median of 474 (interquartile range 390-544) unique VisualDx sessions per month. VisualDx was accessed most frequently through mobile devices (35%) and the inpatient electronic health record (34%). Prior to VisualDx introduction, there was a non-significant increase in the number of inpatient dermatology consultations requested per month at the flagship hospital of our healthcare system (1.0 per month, 95% CI -2.5-4.6, p=0.54), which remained 1.0 consults per month (95% CI -0.9-2.9, p=0.27) following its introduction (p=0.99 comparing post- versus pre-introduction rates). The DDX generator VisualDx was regularly used, primarily on mobile devices and inpatient workstations, and was not associated with a change in inpatient dermatology consultation requests. Given the interest in DDX generators, it will be important to evaluate further the impact of such tools on the quality and value of care delivered.

Experience of a year of adult hospital dermatology consultations.

Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. We aim to describe the spectrum of skin diseases encountered and the health care subspecialties requesting dermatology hospital consultations. We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses. Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services.

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

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. 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. A total of 211 patients had 235 admissions. Mean age was 57.7years (range 3.8-92.1years). 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, 2-5days) for wet dressings and 22days (interquartile range, 21-24days) for Goeckerman therapy. 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.

Pediatric Dermatology Clinical-Pathologic Cases: A Spectrum of Purpuric Disorders of Childhood

In the following sections, we will present three recent cases of pediatric purpura encountered on the inpatient dermatology consult service from a tertiary pediatric hospital. In all cases, the final diagnoses were established with dermatopathologic-clinical correlation and special stains.

DRG benchmarking: analysis of service structures and -differences in dermatology departments.

In the context of DRG-based hospital funding, the analysis of services provided in dermatologic inpatient care is highly relevant. We analyzed and compared clinical service structures and varieties in dermatologic hospitals through a benchmarking technique. For this multicenter cross-sectional study, routine data from 46 German dermatologic clinics and departments were collected, processed, and analyzed. In total, 95 257 data sets from 2011 were available. The data were grouped according to the G-DRG-system 2013 version. The average length of stay for all cases was 6.3 days (DRG "inliers": 5.7 days), and average patient age was 52 years. In total, 55 % of all cases were grouped to medical, 45 % to surgical DRGs. 71 % of all hospitals provide services within or close to this average value (± 10 %). No association was found between the number of hospital beds and the variety of clinical services provided in our sample. We found huge varieties in several parameters assessing the coding quality. The results reflect the heterogeneous reality in German inpatient dermatology. The varieties in dermatologic service range still depend on patient-related factors as well as infrastructural conditions and the resources available at each site.

The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients. To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations. Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists. The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations. Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The Kendall τ rank correlation coefficients for initial triage concordance between the in-person dermatologist and teledermatologists were 0.41 and 0.48. The Cohen κ coefficients for decision to biopsy concordance were 0.35 and 0.61. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge. Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.

Assessing Health-related Quality of Life in Hand Eczema Patients: How to Overcome Psychometric Faults when Using the Dermatology Life Quality Index

Health-related quality of life (HRQOL) has become an important patient reported outcome in health service research. The dermatology life quality index (DLQI) is the most commonly used instrument in dermatology. In recent years, the psychometric properties of the DLQI have been a subject of debate as requirements of modern test theory seem not to be fulfilled. The aim of this study was to test whether those violations also occur in patients with hand eczema. We collected data of 602 hand eczema patients who participated in an inpatient dermatology rehabilitation program in Germany. In order to report meaningful scores of the DLQI, data were analysed according to the principles of modern test theory. We calibrated the DLQI using the Rasch model, resulting in a 6 item version with a range between 0-15 points. This version showed no significant misfit to the Rasch model (p>0.14). By using a Rasch analysis the results were evaluated in a second sample of hand eczema patients (n=511). Even if all demographic characteristic of this sample were different, we were able to replicate the results found in this study (p>0.21). In conclusion, we recommend to use an alternative scoring procedure as presented in this article if the DLQI is used in hand eczema patients.

Inpatient dermatology: Pattern of admissions and patients’ characteristics in an Australian hospital

To report the pattern of dermatology admissions and inpatient characteristics at a tertiary Australian hospital and compare the data with international studies. The study was conducted at a tertiary referral hospital in New South Wales, Australia. Clinical databases were searched retrospectively to include all inpatient admissions under dermatology from 1 January to 31 December 2011. The medical records were reviewed to gather data on age, sex, ethnicity, length of stay, referral and follow-up source, diagnosis and other consultations obtained during the admission. In all, 97 patients were admitted during the 12-month period, of whom 44% were female and 56% male. The most frequent reasons for admission were dermatitis or eczema and ulcers. The average length of stay was 10 days, with a median of 5 days. A total of 80% of patients had a stay duration of 10 days or less, and 6% were in hospital for more than 30 days. The diagnosis that accounted for the longest length of stay was ulcers. A large proportion of patients required consultation from another medical specialty during their admission with 91 specialist consultations taking place for the study group. Inpatient treatment plays a fundamental role in the management of complex and severe dermatological disease and comparison of these results to future studies in other dermatology units around Australia and internationally may be a valuable area of further work.

Antibiotic Sensitivity and Resistance Patterns in Pediatric Staphylococcal Scalded Skin Syndrome

Historical resistance patterns often guide empiric antibiotic choices in staphylococcal scalded skin syndrome (SSSS), but little is known about the difference in susceptibility between SSSS and other childhood staphylococcal infections. A retrospective chart review of culture-confirmed cases of SSSS seen in the inpatient dermatology consultation service at the Children's Hospital of Philadelphia between 2005 and 2011 was performed. Most cases of SSSS at our institution are due to oxacillin-susceptible Staphylococcus aureus, and approximately half of the cases are due to clindamycin-resistant strains. Clindamycin and a penicillinase-resistant penicillin are suggested as empiric treatment for SSSS until culture susceptibility data are available to guide therapy.

Inpatient dermatology: profile of patients and characteristics of admissions to a tertiary dermatology inpatient unit in São Paulo, Brazil

Dermatology is primarily an outpatient clinical and surgical specialty, but substantial numbers of patients are admitted to hospital for inpatient treatment in dermatology wards. We performed a retrospective study of patients admitted to dermatology beds between September 1, 2002, and September 30, 2010. Patient data were analyzed for age, gender, ethnicity, length of stay (LoS), dermatologic disease, comorbidities, hospital-acquired infection (HAI), transfer to the intensive care unit (ICU), and mortality. A total of 3308 patients admitted during this 8-year period were identified for analysis. The most frequent admissions were for eczema/dermatitis (17.5%) and cutaneous infections (15.9%). The mean LoS was 13.0days. The mean±standard deviation (SD) number of comorbidities per patient was 1.0±1.2, among the most frequent of which were hypertension and diabetes mellitus. The rate of HAI was 6.2%; bloodstream infection was regarded as the most commonly acquired type and Staphylococcus aureus as the infectious agent most commonly found in culture. Of the patients admitted, 3.7% were transferred to the ICU and 2.5% died. In these latter two groups, the most common dermatologic diagnoses were immunobullous diseases, and the mean hospital LoS and rate of HAI were higher than in the total admissions cohort. Higher value should be placed on dermatology inpatient services in order to expand the availability of dermatology beds, mainly in tertiary hospitals, in view of the potentially high severity of the dermatologic diseases found in many patients referred to this type of service.

Inpatient Dermatology Consultation in a Spanish Tertiary Care Hospital: A Prospective Cohort Study

Background and objectiveAlthough dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. Material and methodsIn this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. ResultsThe 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). Discussion and conclusionsTo date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.