Resident's Forum
Dermatologic Emergencies
RF- Las urgencias en dermatología
L. Francés Rodríguez
, M. Leiva-Salinas
Corresponding author
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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Francés Rodríguez, M. Leiva-Salinas" "autores" => array:2 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Francés Rodríguez" "email" => array:1 [ 0 => "frances.rodriguez.laura@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Leiva-Salinas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "RF- Las urgencias en dermatología" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 1600 "Tamanyo" => 196059 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Skin lesions clinically compatible with dermatomyositis. C, As paraneoplastic dermatomyositis was suspected, a tumor-screening study was performed, which detected a resectable neoplastic lesion in the lung.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The frequency of dermatologic emergencies varies considerably between studies, but it is estimated that up to 10 to 14 urgent consultations are seen each day in Spanish hospitals. Of these, approximately 40% are pediatric cases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Although it is true that the majority of dermatologic diseases do not require immediate specialist care, the dermatologist is under increasing demand by the population, both for rapid diagnosis and for treatment, irrespective of the seriousness of the diagnosis. In a study published on this subject by colleagues in Hospital Ramón y Cajal in Madrid, Spain, it was found that only half of all urgent dermatologic consultations were justified: 95% of patients under 30 years of age came with no urgent pathology, versus 6% of patients aged over 65 years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, it must not be forgotten that some patients with dermatologic diseases who come to an emergency department do so for skin changes that may be the first and only indication of a serious systemic disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> When such manifestations develop, it is therefore important to suspect the diagnosis and to perform the appropriate investigations early, as the dermatologic diagnosis could be crucial to the life of the patient. This can be seen in certain paraneoplastic dermatoses, vasculitides, serious skin and soft-tissue infections, blistering diseases, severe toxic dermatitis, etc. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In addition, it must be noted that certain dermatologic diseases, while not being an immediate threat to the life of the patient, can give rise to visible lesions that may provoke great distress due to their extension and appearance, particularly in children. Also, lesions can often provoke intense pruritus,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> a symptom that can be so severe as to be disabling.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, it is important to take into account the large proportion of patients that erroneously uses the emergency consultation service for routine consultations because of the delay in obtaining specialist consultations due to the large care load. Here the role of the primary care physician becomes essential to avoid overload, informing patients of the benign nature of certain lesions with an obvious diagnosis (such as seborrheic keratoses, solar lentigines and skin tags), which do not require specialist evaluation or treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For the general physician, dermatologic diseases seen in the emergency room can be highly complex for various reasons: the need for a diagnosis at the first observation of a lesion, the wide variety of diagnoses seen, and the fact that the relevance of a single type of dermatologic lesion can change according to the clinical context. In these situations, the emergency physician can only make nonspecific and descriptive diagnoses, and the patient may be inadequately evaluated.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In conclusion, we consider that on-call dermatology duties should be established in the majority of Spanish hospitals, especially in those hospitals with residents in training, or else protocols should be drawn up for urgent specialist referral from the general emergency department, for patients to be seen within a maximum of 24 to 48<span class="elsevierStyleHsp" style=""></span>hours. In this way, the dermatologist can make a more accurate diagnosis, avoid aggressive tests and treatments, take a diagnostic biopsy during the acute phase of diseases that evolve over a few days, schedule follow-up in dermatology outpatients more effectively, and avoid the admission to hospital of pathologic conditions that can be managed on an outpatient basis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-27" "fechaAceptado" => "2014-07-30" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec515904" "palabras" => array:3 [ 0 => "Dermatologic Emergencies" 1 => "Diagnosis" 2 => "Severity" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Francés Rodríguez L, Leiva-Salinas M. RF- Las urgencias en dermatología. Actas Dermosifiliogr. 2015;106:322–323.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 1600 "Tamanyo" => 196059 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Skin lesions clinically compatible with dermatomyositis. C, As paraneoplastic dermatomyositis was suspected, a tumor-screening study was performed, which detected a resectable neoplastic lesion in the lung.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias dermatológicas: análisis descriptivo de 861 pacientes en un hospital terciario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Grillo" 1 => "S. Vañó-Galván" 2 => "N. Jiménez-Gómez" 3 => "A. Ballester" 4 => "E. Muñoz-Zato" 5 => "P. 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De Giorgi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1529-8019.2010.01365.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "581" "paginaFinal" => "589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21054704" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interest of emergency dermatological consultation in a regional hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Wakosa" 1 => "A. Roussel" 2 => "M. Delaplace" 3 => "E. Le Bidre" 4 => "R. Binois" 5 => "A. 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Betlloch-Mas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "233" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18358204" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000591/v2_201505051007/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000004/v2_201505051007/S1578219015000591/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000591?idApp=UINPBA000044" ]
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| 2020 March | 33 | 15 | 48 |
| 2020 February | 7 | 3 | 10 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 1 | 5 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 11 | 15 |
| 2019 May | 6 | 8 | 14 |
| 2019 April | 2 | 2 | 4 |
| 2019 March | 4 | 8 | 12 |
| 2019 February | 2 | 1 | 3 |
| 2019 January | 2 | 1 | 3 |
| 2018 December | 2 | 3 | 5 |
| 2018 November | 0 | 3 | 3 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 3 | 0 | 3 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 30 | 3 | 33 |
| 2018 January | 33 | 3 | 36 |
| 2017 December | 32 | 8 | 40 |
| 2017 November | 27 | 5 | 32 |
| 2017 October | 27 | 6 | 33 |
| 2017 September | 20 | 10 | 30 |
| 2017 August | 40 | 5 | 45 |
| 2017 July | 26 | 9 | 35 |
| 2017 June | 27 | 8 | 35 |
| 2017 May | 26 | 5 | 31 |
| 2017 April | 30 | 3 | 33 |
| 2017 March | 22 | 6 | 28 |
| 2017 February | 24 | 4 | 28 |
| 2017 January | 21 | 4 | 25 |
| 2016 December | 37 | 12 | 49 |
| 2016 November | 35 | 12 | 47 |
| 2016 October | 34 | 16 | 50 |
| 2016 September | 0 | 1 | 1 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 0 | 2 | 2 |
| 2016 May | 0 | 1 | 1 |
| 2016 April | 0 | 6 | 6 |
| 2016 March | 0 | 3 | 3 |
| 2016 February | 0 | 2 | 2 |
| 2015 November | 12 | 1 | 13 |
| 2015 October | 5 | 2 | 7 |
| 2015 September | 3 | 4 | 7 |
| 2015 August | 4 | 5 | 9 |
| 2015 July | 23 | 4 | 27 |
| 2015 June | 26 | 5 | 31 |
| 2015 May | 82 | 51 | 133 |
Show all
