Recognizing skin emergencies
Session prepares hospitalists for dermatologic emergencies.
Former primary care physician and hospitalist-turned dermatologist, Thomas D. Selby, MD, knows all too well the kind of skin conditions that can challenge hospitalists. Dr. Selby is a general dermatologist at Deaconess Health System in Evansville, Indiana, and director of Friday’s session, “Expand Your Skinfluence: An Update on Inpatient Dermatologic Emergencies.”
The session’s case-based review of various inpatient dermatologic emergencies will better prepare hospitalists for recognizing, identifying, and treating such conditions, including understanding the role of skin tone and proper workup, Dr. Selby said.
“The identification of these emergencies can be tricky. They all start with skin changes of one kind or another, usually erythema (redness) and pain,” he said.
According to Dr. Selby, hospitalists could potentially see a wide range of dermatologic emergencies. Many of them overlap with other specialties, particularly infectious disease or rheumatology. Typically, he said, true skin emergencies are related to an underlying drug reaction or infectious etiology. As such, Dr. Selby will address some of the more prototypical skin emergencies hospitalists see, including toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, acute generalized exanthematous pustulosis (AGEP), and generalized pustular psoriasis (GPP).
Skin pain (versus itch) associated with a rash is a good clue to be more concerned about the skin changes, Dr. Selby said. As for workup and treatment, it depends on the type of emergency. However, it typically involves checking general labs to rule out other organ involvement and doing a thorough review of the patient's medication history.
“Almost always there is a culprit medication that needs to be immediately stopped and avoided in the future,” he said.
Another rising issue challenging hospitalists is the skin condition side effects related to cancer treatment. Dr. Selby notes the impact of immunotherapy on the skin. Although it is a significant advancement in the world of oncology, he said, some of the more common side effects of immunotherapy are skin related. Those skin conditions can range from mild to severe, and dermatologists work very closely with oncology to manage these symptoms to allow patients to stay on their immunotherapy as much as possible.
“Interestingly, many of the skin side effects of immunotherapy carry a positive prognostic implication for the cancer being treated,” he said. “Thankfully, many of the skin side effects of immunotherapy are not dangerous or an emergency.”
Friday’s session will also address new treatment options and management strategies available to hospitalists. Dr. Selby said his goal is to help hospitalists feel comfortable and confident in assessing their patients for potential dermatologic emergency no matter their skin tone as well as prepare them in the necessary steps to manage a dermatologic emergency, which can be critical for patient morbidity and mortality.
“As a former primary care physician and hospitalist, I know how valuable SHM was in continuing my education,” Dr. Selby said. “Now, as a dermatologist, I hope I can pass along some knowledge to help my hospitalist colleagues with the care of their patients.”
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