Several Dermatological Conditions Require Additional Care and Referral to Specialized Medical Institutions

Certain skin conditions warrant referral and additional care beyond primary dermatology clinics, according to an analysis and report published in the Journal of the European Academy of Dermatology and Venereology.¹

Among a Japanese cohort, researchers reported a large number of both general and emergency referrals to specialized medical institutions for drug-induced skin reactions, malignant tumors, and more.

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Background and Methods

Previous studies have explored referrals from inpatient departments to dermatology departments. For example, a study from the Indian Dermatology Online Journal reported that the majority of dermatology referrals (49.3%) stemmed from internal medicine departments. Other referrals came from departments of surgery, pediatrics, psychiatry, and gynecology, among others.²

However, fewer studies have explored referrals from dermatology clinics to other medical specialties, such as emergency care. Noting that patients with skin conditions can be seen and treated by other non-dermatologist physicians, researchers Ueo et al sought to explore patterns of referral from a dermatology clinic to specialized medical institutions.

The study involved 14,306 patients from the Ueo Dermatology Clinic in Saiki City, Japan, treated exclusively between January 2020 and December 2022. Clinical records provided data on primary diseases, patient demographics, and referral details. Referrals were categorized into emergency or general types, with reasons for referrals classified into 7 categories such as the need for immediate treatment, unclear diagnosis, or specialized care.

Findings

Demographic data reveal a median patient age of 53 years across the total population. Patients requiring general and emergency referrals tended to be older, with median ages of 65 and 71 years, respectively.

The study categorized diseases treated at the clinic into various groups and examined their referral patterns.

Researchers found that atopic dermatitis was the most common condition reported among all patients, but only a small percentage (0.24% general; 0.02% emergency) required referrals. While atopic dermatitis is prevalent, it is often managed more effectively within the primary clinic setting, according to researchers. Similarly, contact dermatitis and acute eczema were also frequently seen but did not yield high referral rates.

Herpes zoster was a leading cause of emergency referrals, aligning with the understanding that certain viral infections can present acutely and require immediate specialized care.

Furthermore, diseases such as basal cell carcinoma and squamous cell carcinoma were frequently referred for general consultations. Malignant skin tumors and melanomas yielded a 75.71% general referral rate and a 1.43% referral to emergency care.

Benign skin tumors such as seborrheic keratosis and epidermal cysts was high for general referrals, and drug-induced skin reactions demonstrated a significant emergency referral rate of 4.39%.

Conclusions

Potential limitations of the study, as noted by researchers, included its use of results from a single primary clinic and clinician. Additionally, results stemming solely from Japan may limit its generalizability on a global scale.

"This study identified several skin conditions often requiring additional care when treated at a primary dermatological clinic," according to Ueo et al. "Based on these findings, seamless cooperation between primary clinics and specialised medical institutions is anticipated."

References

1. Ueo D, Sakai T, Ochiai E, Sese J, Hatano Y. Analysing referral patterns from a primary dermatological clinic to other medical institutions for further care: a survey on patients with certain skin diseases in Japan. J Eur Acad Dermatol Venerol. August 13, 2024. https://doi.org/10.1002/jvc2.517
2. Balai M, Gupta LK, Khare AK, Mittal A, Mehta S, Bharti G. Pattern of inpatient referrals to dermatology at a tertiary care centre of South Rajasthan. Indian Dermatol Online J. 2017 Jan-Feb;8(1):25-28. doi: 10.4103/2229-5178.198759