Includes Index

Welcome to inpatient dermatology!
This book aims to fill a novel space in dermatology education: the recognition
and appropriate initial management of key dermatologic diseases you will encounter in the inpatient setting. Inpatient dermatology is an exciting, dynamic, and challenging field that may seem overwhelming in the beginning. We hope that this book
will help provide the reader with a practical initial approach to the complex patient.
Dermatology is unique in that its organ of study is visible to the naked eye, often
providing clues to the etiology of systemic diseases (including autoimmune, infectious, and neoplastic conditions) that otherwise span a variety of disciplines.
Therefore, an informed assessment of the skin is an invaluable component of the
inpatient workup. As such, this textbook is not geared solely toward dermatologists
but also may be used as a resource for anyone who cares for patients in the hospital
setting. By providing essential information in a concise, usable package, we hope to
provide a systematic approach for evaluating inpatients with cutaneous pathology.
We have attempted to provide concise, bulleted, easy-to-read-and-reference, key
material to help physicians diagnose and differentiate the dermatologic diseases that
occur in the inpatient setting. Each brief chapter is focused on one specific inpatient
dermatologic condition, with carefully curated clinical photographs and corresponding histopathologic images to aid readers in developing clinical-pathologic correlation
and pattern recognition for these entities. We have provided a list of essential differential diagnoses which are important to consider and a day-one, initial workup and management plan for each condition. The sections are preceded by diagnostic pearls from
the editors, where we share our approach to these often-challenging conditions.
The literature underscores the importance of inpatient dermatology consults by
demonstrating that skin findings are often overlooked by non-dermatologists in hospitalized patients, with over three quarters of patients’ relevant skin findings not noted
by the primary team. One study demonstrated that when dermatologists consult on
hospitalized patients, the diagnosis and/or treatment is changed 60% of the time.
Other works have demonstrated that involving a dermatologist in the evaluation of
common diagnoses such as cellulitis can reduce misdiagnoses (as one large study
demonstrated, 75% of cases of “cellulitis” may instead represent pseudocellulitis, stasis dermatitis, contact dermatitis, Lyme, and other entities). Therefore, it is paramount
that physicians, regardless of their specialization, are attentive to cutaneous findings
so they can request the appropriate consultation or provide the appropriate review In this era of cost-conscious care and penalties for readmission, it is important
dermatologists are able to identify and mitigate some of the cutaneous risk factors
for cellulitis, so that they can guide management and reduce recurrent disease and
readmissions. A study in England demonstrated that involving dermatologists in the
diagnosis and management of lower limb cellulitis led to alternate diagnoses in 1/3
of cases and dramatically reduced the need for inpatient admission. Finally, emerging data suggest that simply having timely access to inpatient dermatologists can
lead to reduced mortality and improved overall survival in patients presenting with
Stevens-Johnson syndrome/toxic epidermal necrolysis.
This book is not a comprehensive textbook covering the breadth of dermatology;
our focus is to guide point-of-care physicians as they are confronted with skin problems in hospitalized patients. The initial workup that we present is detailed and
designed to help clinicians narrow their differential and hone in on a specific diagnosis and treatment plan. Our suggested evaluation is not exhaustive—what we
have laid out should help clinicians make the vast majority of correct diagnoses and
exclude alternate possibilities in a prompt and economical manner.
As with any text, the pages herein may quickly become outdated as the practice
of medicine evolves. Inpatient medicine in particular is a rapidly changing environment: Patients present with novel acute illnesses, new pathogens and patterns of
antibiotic resistance emerge, and cutaneous side effects result from clinical trial
drugs and cutting-edge chemotherapeutic regimens. When evaluating inpatients, it
is always worthwhile to consider searching the primary medical literature. The contents of these pages are designed to give a structured, algorithmic framework for
evaluating inpatients, but should not be used in isolation to decide on treatment
plans. Instead, each individual patient and case represent a unique combination of
comorbidities and problems, requiring a tailored approach.
The practice of inpatient dermatology is humbling, and in many cases a specific
final diagnosis is elusive. The approach we advocate is to cast a wide net, considering a broad array of differential diagnoses, and then to supplement the patient’s
history and clinical exam with a focus on the specific cutaneous morphology, using
appropriate diagnostic tests to narrow in on a more focused differential or specific
diagnosis. This textbook is designed to help guide that process, with a mind toward
cost-conscious care and avoiding unnecessary, extraneous laboratory evaluations
whenever possible. We hope readers find the format and content helpful as they care
for these challenging conditions and help improve the health and lives of inpatients
suffering from skin disease or cutaneous manifestations of systemic illness or
treatments.
We hope you find this text helpful in your evaluation and management of inpatients with dermatological issues!