Resident's Forum
Dermatologic Emergencies
RF- Las urgencias en dermatología
L. Francés Rodríguez
, M. Leiva-Salinas
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Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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"apellidos" => "Rodríguez Prieto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014005158" "doi" => "10.1016/j.ad.2014.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014005158?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500058X?idApp=UINPBA000044" "url" => "/15782190/0000010600000004/v2_201505051007/S157821901500058X/v2_201505051007/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "Dermatologic Emergencies" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "322" "paginaFinal" => "323" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. 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" ]
| año/Mes | Html | Total | |
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| 2020 Noviembre | 31 | 18 | 49 |
| 2020 Octubre | 19 | 6 | 25 |
| 2020 Septiembre | 41 | 8 | 49 |
| 2020 Agosto | 17 | 16 | 33 |
| 2020 Julio | 23 | 12 | 35 |
| 2020 Junio | 37 | 21 | 58 |
| 2020 Mayo | 26 | 24 | 50 |
| 2020 Abril | 27 | 15 | 42 |
| 2020 Marzo | 33 | 15 | 48 |
| 2020 Febrero | 7 | 3 | 10 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 11 | 15 |
| 2019 Mayo | 6 | 8 | 14 |
| 2019 Abril | 2 | 2 | 4 |
| 2019 Marzo | 4 | 8 | 12 |
| 2019 Febrero | 2 | 1 | 3 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 2 | 3 | 5 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 30 | 3 | 33 |
| 2018 Enero | 33 | 3 | 36 |
| 2017 Diciembre | 32 | 8 | 40 |
| 2017 Noviembre | 27 | 5 | 32 |
| 2017 Octubre | 27 | 6 | 33 |
| 2017 Septiembre | 20 | 10 | 30 |
| 2017 Agosto | 40 | 5 | 45 |
| 2017 Julio | 26 | 9 | 35 |
| 2017 Junio | 27 | 8 | 35 |
| 2017 Mayo | 26 | 5 | 31 |
| 2017 Abril | 30 | 3 | 33 |
| 2017 Marzo | 22 | 6 | 28 |
| 2017 Febrero | 24 | 4 | 28 |
| 2017 Enero | 21 | 4 | 25 |
| 2016 Diciembre | 37 | 12 | 49 |
| 2016 Noviembre | 35 | 12 | 47 |
| 2016 Octubre | 34 | 16 | 50 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Julio | 0 | 1 | 1 |
| 2016 Junio | 0 | 2 | 2 |
| 2016 Mayo | 0 | 1 | 1 |
| 2016 Abril | 0 | 6 | 6 |
| 2016 Marzo | 0 | 3 | 3 |
| 2016 Febrero | 0 | 2 | 2 |
| 2015 Noviembre | 12 | 1 | 13 |
| 2015 Octubre | 5 | 2 | 7 |
| 2015 Septiembre | 3 | 4 | 7 |
| 2015 Agosto | 4 | 5 | 9 |
| 2015 Julio | 23 | 4 | 27 |
| 2015 Junio | 26 | 5 | 31 |
| 2015 Mayo | 82 | 51 | 133 |
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