Dermatology for the Hospitalist-Slides

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This presentation by Dr. Steven T. Chen focuses on dermatological conditions relevant to hospitalists, emphasizing recognition, diagnosis, and initial management of severe cutaneous eruptions in hospitalized patients before dermatology consultation.<br /><br />Key topics include severe drug reactions such as Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). SJS/TEN typically present with dusky, targetoid lesions, mucosal involvement, and positive Nikolsky sign, often triggered by drugs like trimethoprim/sulfamethoxazole. Prognostication tools like SCORTEN help estimate mortality risk. Treatment includes immediate discontinuation of the offending agent, supportive wound care (often in burn units), judicious antibiotic use, and specialist consultations, with systemic immunosuppression (e.g., steroids, IVIG, cyclosporine) considered despite limited conclusive evidence.<br /><br />DRESS syndrome manifests 2-6 weeks post drug exposure, commonly from antiepileptics and antibiotics, featuring systemic symptoms, eosinophilia, and organ involvement including myocarditis. Diagnostic criteria (RegiSCAR) and viral reactivation testing aid diagnosis. Management involves stopping the causative drug and systemic corticosteroids, sometimes IVIG or cyclosporine, with close monitoring for long-term autoimmune sequelae.<br /><br />The presentation also covers differentiating cellulitis from mimickers like stasis dermatitis, emphasizing careful clinical assessment and the limited role of broad antibiotic coverage.<br /><br />Additional dermatologic conditions discussed include leukocytoclastic vasculitis (cutaneous small vessel vasculitis), retiform purpura indicative of vasculopathy or vasculitis, and neutrophilic dermatoses such as pyoderma gangrenosum, which require immunosuppressive therapy and avoidance of surgical debridement.<br /><br />General treatment tips highlight selecting appropriate topical steroids and antifungals, cautioning against steroids in fungal infections and recognizing the complexity in immunosuppressed patients.<br /><br />Overall, early identification of skin manifestations, knowledge of drug reaction timelines, and prompt management can be life-saving. Collaboration with dermatology is essential for severe cutaneous adverse reactions and complex presentations.

Keywords

Stevens-Johnson Syndrome

Toxic Epidermal Necrolysis

DRESS syndrome

Severe cutaneous eruptions

Drug reactions

SCORTEN mortality score

Systemic immunosuppression

Leukocytoclastic vasculitis

Pyoderma gangrenosum

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