Pattern of admissions to a tertiary dermatology unit in South Africa.

BACKGROUND: There is worldwide recognition of the need to control the rising costs of health-care. As a result there is a trend away from inpatient treatment of people with non-life-threatening skin disorders. In the developing world there is a conflict between the inadequacy of home and community facilities and the need to limit expenditure. AIM: The aims of this study were to assess the current indications for admission to a dermatology ward, the level of domestic and community facilities among those admitted, and the apparent benefits obtained from such admissions. METHODS: Over a 6-month period all patients admitted to the tertiary dermatology unit at Groote Schuur Hospital were recruited and a questionnaire was completed by the admitting doctor. On discharge, patients and doctors were asked to assess the level of improvement in the patient's skin disorder. RESULTS: There were 133 people admitted, with a mean age of 34.1 years (range 1-88). Diagnoses recorded most often were atopic dermatitis (44), other forms of dermatitis (18), psoriasis (21), severe drug reaction (10), leg ulcer (7), skin infection (7) and bullous disease (6). Overall, the extent and severity of the skin involvement was the major indication for admission, although psychosocial problems and a lack of home facilities were contributing factors. A group of 25 people had been admitted to the ward on 2 or more occasions over the preceding 2 years. This group did not differ from the rest of the patients in terms of diagnosis, home circumstances or level of employment. CONCLUSIONS: Most admissions to a tertiary dermatology unit in Cape Town are for extensive eczema or psoriasis. Most people experience great short-term benefit from inpatient care. The group of people who require repeated admissions do not appear to differ from the total group by diagnosis or available facilities, but may represent a psychosocially vulnerable subset.

Histometric data obtained by in vivo confocal laser scanning microscopy in patients with systemic sclerosis.

BACKGROUND: It would be a benefit if time-saving, non-invasive methods could give hints for diagnosing systemic sclerosis. To investigate the skin of patients with systemic sclerosis using confocal laser scanning microscopy in vivo and to develop histometric parameters to describe characteristic cutaneous changes of systemic sclerosis observed by this new technique, we conducted an exploratory study. MATERIALS AND METHODS: Fifteen patients with systemic sclerosis treated with extracorporal photopheresis were compared with 15 healthy volunteers and 10 patients with other disorders also treated with extracorporal photopheresis. All subjects were investigated using confocal laser scanning microscopy in vivo. RESULTS: Micromorphologic characteristics of skin of patients with systemic sclerosis and measuring parameters for melanisation, epidermal hypotrophy, and fibrosis for dislocation of capillaries by collagen deposits in the papillary dermis were evaluated. An interesting finding was an increased thickness of the tissue in the dermal papillae superior to the first dermal papilla vessel. It was also possible to reproduce characteristic histologic features by confocal laser scanning microscopy in vivo. Histometric parameters for fibrosis and vascular features developed in this study showed significant differences in patients with systemic sclerosis compared to controls. CONCLUSIONS: Although the predominant histopathological features in systemic sclerosis are findings of the reticular dermis and the subcutis, and in histopathological investigation the epidermis seems to remain unaffected by the disease, we have demonstrate some characteristic differences in the epidermis and papillary dermis by confocal laser scanning microscopy in vivo. Some of them have not been described so far. However, to use this technique as a tool for diagnosis and/or staging of systemic sclerosis, further studies are needed investigating the sensitivity and specificity of the histometric parameters developed in this study.