Chapter 11-06: Key Clinical Trials and Publications in Dermatology

INPATIENT DERMATOLOGY

• Prevalence of cutaneous findings in hospitalized medical patients. J Am Acad Dermatol 1995;33(2 Pt 1):207–211.

  • - Observational study in which patients admitted to medical services were examined by a dermatologist within 48 hours to determine if cutaneous findings had been overlooked. Of examined patients (n = 231), 31 patients (13.4%) had cutaneous signs related to the reason for hospitalization or associated with a systemic disorder. For 14 patients, the primary team had not recognized these skin findings.

• Association of dermatology consultation with accuracy of cutaneous disorder diagnoses in hospitalized patients. JAMA Dermatol 2016;152(4):477–480.

  • - Observational study in which primary teams’ vs. dermatology teams’ final diagnoses were compared at multiple academic centers. Dermatology consultation changed the final diagnosis in 71% of consultation requests. Cellulitis, leg ulceration, and viral infections were the three most commonly undiagnosed and misdiagnosed conditions by the referring team. The authors conclude that dermatology consultation is associated with improved diagnostic accuracy of cutaneous disorders in hospitalized patients and facilitates early appropriate intervention.

• Association of dermatology consultations with patient care outcomes in hospitalized patients with inflammatory skin diseases. JAMA Dermatol 2017;153(6):523–528.

  • - Retrospective, single-center study that examined the impact of dermatology consultation on readmission within 1 year and length of stay for patients with inflammatory skin conditions. Findings demonstrated that dermatology consultations were associated with reduction in readmission within 1 year and reduction in length of stay by 2.6 days (95% CI 1.75–3.5 days).

• Outcomes of early dermatology consultation for inpatients diagnosed with cellulitis. JAMA Dermatol 2018;154(5):537–543.

  • - Prospective cohort study that enrolled 116 patients with presumed cellulitis in the emergency department, in the emergency department observation unit, or within 24 hours of inpatient admission to receive a dermatology consult. For patients with presumed cellulitis, early consultation by dermatologists improved health-related outcomes through the reduction of inappropriate antibiotic use and hospitalization.

CELLULITIS AND CELLULITIS MIMICKERS

• Effect of dermatology consultation on outcomes for patients with presumed cellulitis. JAMA Dermatol 2018;154(5):529–536.

  • - Randomized clinical trial of 175 hospitalized adults where patients were randomized to intervention (dermatology consult) vs. control (no dermatology consult, standard of care). The length of intravenous antibiotic use was significantly shorter, and the 2-week improvement rate was significantly higher in patients in the intervention group (dermatology consult), suggesting that inpatient dermatology consult may enhance patient outcomes by improving diagnostic accuracy and facilitating antibiotic stewardship in hospitalized patients with suspected cellulitis.