Severity grading of dermatological emergencies based on comorbidities and systemic involvement: An observational study.

ABSTRACT

Dermatological emergency is defined as any urgent/immediate care. Dermatological conditions compromise about 5-8% of all cases presenting to the emergency department. A grading system can help dermatologist's and allied medical personnel to triage a patient accordingly. Currently no severity grading for dermatological emergencies is available. All patients seen in OPD for dermatological consultations requiring urgent interventions were included. Detailed history and clinical examination were done. Patients were assessed according to the onset, symptoms, distribution, examination, body surface area percentage and mucosal involvement. The severity was graded separately based on comorbidities and systemic involvement. Grade I was no comorbidity or systemic involvement. Grade II was 1 comorbidity or systemic involvement. Grade III was 2 comorbidities or systemic involvement. Grade IV was > 2 comorbidities or multiorgan involvement. Interesting emergency cases observed in Covid period were noted. There were 202 cases, the most common age group was 19-64 (69.8%). Male (49%) and females (51%) had equal preponderance. Most common emergency was acute urticaria with or without angioedema (25.24%). There were 113 (55.94%) inpatients and 89 (44.05%) were outpatients. Acute on chronic onset (34.5%), pain (41.6%), vesicles (30.1%), erosion (23.9%), ulcers (9.7%) and more than 50% body surface area involvement (64.6%) were seen more in admitted cases. Grade I was most common for both comorbidities and systemic involvement. However, grades II, III and IV were higher in admitted cases for both grading systems. The presence of comorbidities and systemic involvement increases the severity of dermatological emergency. Six patients had relapse. Seven patients had methotrexate toxicity. The proposed grading system based on comorbidities and systemic involvement helps to assess the severity of dermatological emergencies.