Inpatient teledermatology service: baseline review - it works!

Setting up an inpatient teledermatology service over 1 year at our National Health Service-based district general hospital made absolute sense on two grounds: The COVID pandemic and the ever-increasing role of teledermatology enabling dermatology departments, often with limited resources, to 'work smart'. Over a 43-week period, 124 referrals were dealt with on our teledermatology platform (around 12 referrals per month). Average response time to referral was 0.65 days: 56% same-day response, 32% next-day response;and 92% a response within 3 days. Following this, 32% of patients were seen face to face on the wards and 40% were dealt with via remote advice and guidance. Around 10% of referrals were deemed not to be appropriate for dermatology review/advice. Around 12% of referrals were given dermatology face-to-face outpatient appointments rather than review on the wards, and 7% were declined an appointment (pending further information being received) as insufficient information was given for triage/advice and guidance. Initially, just 10% of referrals were sent (first time) with clinical images, but this increased to 54% after 4 months, and although there has been some monthly variation, up to 64% has been achieved (noting that clinical images are not always required for the question being asked). Around 50 different diagnoses were made, illustrating the diversity and complexity of dermatological practice, and the scale of the diagnostic problems facing ward-based teams. Previously published data revealed that around one-third of inpatient dermatology referrals were for 'red legs', which was replicated in the current results, with diagnoses of venous or atopic eczema (14%), drug reactions (12%), skin neoplasia (6%), cellulitis/erysipelas (5%), intertrigo (4%), erythroderma (4%), Gianotti-Crosti syndrome (2.5%), bullous pemphigoid (2.5%), pyoderma gangrenosum (2.5%) and vasculitis (2%). Having an inpatient teledermatology service benefits dermatology departments, enabling efficient working, appropriate triage, training opportunities and ease of second opinions from colleagues. Benefits for referrers are acute ward-based teams including rapid responses to referrals, enabling skin concerns to be dealt with quickly and avoiding delays in investigation, treatment and discharge. Some hospitals where dermatology does not have a permanent base may be able to access dermatology advice and guidance via teledermatology. Overall, patients benefit from teledermatology and it is COVID secure.

Viral exanthems Unravelling viral rashes

Common causes of viral exanthems in Australia include herpesviruses, enteroviruses, parvovirus B19, varicella, measles and rubella viruses and mosquito-borne alphaviruses. The cause can often be diagnosed clinically from the rash distribution and morphology, confirmed only when necessary with serological or PCR tests. Most viral exanthems are self-limiting, requiring supportive care alone.

Gianotti-Crosti syndrome related to SARS-COV-2 infection in an infant. Clinical case report

Dermatological manifestations are a frequent sign in the course of covid-19, Gianotti-Crosti syndrome has being observed as a manifestation after sars-cov-2 infection, and should be considered as a possible differential diagnosis. We present the case of an 11-month-old male, who goes to the emergency room with fever of 39.9 °C, is diagnosed as pharyngitis and is discharged home;two weeks later, he went to reassessment due to a maculopapular rash predominantly on the trunk, extremities, anterior and posterior chest, respecting the soles and palms, it was classified as a febrile exanthematous disease. In the context of a covid-19 pandemic, a rapid antigen test was taken with a non-reactive result and serologies for sars-cov-2 igg positive.