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Dermatological conditions account for a significant proportion of Emergency Department (ED) visits but are often misclassified at triage and managed without timely specialist input. A Dermatology Fast Track (DFT) pathway was implemented to improve diagnostic accuracy, optimize resource use, and enhance integration between ED and dermatology services. We conducted a retrospective study of patients referred through the DFT between April 2023 and October 2024. Demographics, triage codes, diagnoses, comorbidities, prior healthcare utilization, treatments, and follow-up were analyzed. Concordance between ED and dermatology-assigned triage codes was assessed using Cohen's kappa, and temporal trends in referrals were explored. Of 621 patients referred, 554 were included (mean age of 47.7 years and balanced sex distribution). Most were triaged green (75.6%) or white (23.1%), and 99.5% were discharged home. Infectious dermatoses (21.1%) and eczema (17.7%) were most frequent, with age-specific variations. Combined topical and systemic therapy was prescribed in 66.1% of cases, and 30.9% were referred for follow-up. Concordance between ED and dermatology triage codes was limited (58.7% agreement; Cohen's kappa 0.25), with frequent down-grading of priority by dermatologists. Seasonal peaks were observed, with higher demand during summer months. The DFT pathway streamlines ED care, ensuring timely management of acute dermatological conditions and reducing overcrowding. Seasonal demand fluctuations and discrepancies in triage highlight the need for targeted staff training, structured follow-up, and resource planning. Overall, the DFT is an effective model for enhancing ED efficiency, diagnostic accuracy, and patient care; however, as outcomes were assessed only in the DFT cohort and the study was conducted in a single center using Italy's color-coded triage system, the generalizability of these findings may be limited. Multicenter studies are needed to confirm its broader applicability.

Background: Dermatological emergencies are critical conditions requiring immediate attention due to their potential to escalate into life-threatening scenarios. Accurate diagnosis and timely management are essential to prevent severe complications, including systemic involvement and mortality. This systematic review summarizes findings on dermatological emergencies in emergency departments (EDs), focusing on diagnostic accuracy, hospitalization rates, systemic complications, and management strategies. Methods: A systematic literature review of studies on dermatological emergencies was conducted, encompassing 24 prospective and retrospective cohort studies, cross-sectional studies, and descriptive analyses. The review included diverse patient populations, examining dermatological presentations, diagnostic methods, treatment strategies, hospitalization rates, and adverse outcomes. Key outcome measures such as diagnostic accuracy, complications, mortality rates, and re-visit frequencies were analyzed. Results: The studies revealed high diagnostic accuracy, particularly in in-person evaluations, with teledermatology showing slightly lower but reliable rates. Systemic complications, including severe drug reactions, bacterial infections, and autoimmune diseases, were common causes of hospitalization. Mortality rates varied, with conditions such as toxic epidermal necrolysis showing the highest risk. Hospitalization rates averaged 4.52%, and re-visit rates ranged from 1% to 6.5%. The results also highlighted the impact of environmental factors and seasonal trends on dermatological presentations. Conclusions: Dermatological emergencies pose significant challenges in emergency care. High diagnostic accuracy and effective management strategies are crucial in preventing severe outcomes. Timely diagnosis, careful management of systemic complications, and teledermatology play critical roles in improving care. Future research should focus on standardized management protocols, telemedicine applications, and the influence of environmental and demographic factors to enhance patient outcomes.

Unnecessary dermatology consultation requests from emergency departments (EDs) are a common occurrence worldwide. This study aimed to analyze the demographic and clinical characteristics of patients consulted to the dermatology department for dermatologic disorders by a university hospital's pediatric ED (PED) and adult ED (AED). The electronic medical records of 2316 dermatology consultation requests from the PED and AED during a 5-year period were retrospectively reviewed. Patient demographic and clinical characteristics, dermatological diagnoses, and time of day of dermatology consultation requests from the PED and AED were retrospectively analyzed. The electronic medical records of 1845 consultation requests with complete data were included in the study. There were 969 (52.5%) consultation requests from the PED and 876 (47.5%) from the AED. Mean time from onset of dermatological symptoms to ED presentation was 31.6 d. Herpes zoster infections (18.5%), adverse cutaneous drug reactions (8.1%), and urticaria with angioedema (7.9%) were the most common skin disorders resulting in consultation requests from the AED, versus non-specific viral infections (9.2%), insect bites (8.3%), and atopic dermatitis (8.2%) from the PED. In all, 11.5% of ED patients that received dermatology department consultation required hospitalization due to dermatologic disorders. As patients commonly present to EDs with non-urgent dermatological diseases, ED physicians should receive training on common dermatological diseases so as to decrease the number of unnecessary dermatology consultation requests.

Toxic epidermal necrolysis (TEN) is an acute, life-threatening muco-cutaneous disease, often induced by drugs. It is characterized by muco-cutaneous erythematous and purpuric lesions, flaccid blisters which erupt, causing large areas of denudation. The condition can involve the genitourinary, pulmonary and, gastrointestinal systems. Because of the associated high mortality rate early diagnosis and treatment are mandatory. This article presents the case of a sixty-six years old male patient, known to have cirrhosis, chronic kidney failure, and diabetes mellitus. His current treatment included haemodialysis. He was hospitalized as an emergency to the Dermatology Department for erythemato-violaceous, purpuric patches and papules, with acral disposition, associated with rapidly spreading erosions of the oral, nasal and genital mucosa and the emergence of flaccid blisters which erupted quickly leaving large areas of denudation. Based on the clinical examination and laboratory investigations the patient was diagnosed with TEN, secondary to carbamazepine intake for encephalopathic phenomena. The continuous alteration in both kidney and liver function and electrolyte imbalance, required him to be transferred to the intensive care unit. Following pulse therapy with systemic corticosteroids, hydro-electrolytic re-equilibration, topical corticosteroid and antibiotics, there was a favourable resolution of TEN. The case is of interest due to possible life-threatening cutaneous complications, including sepsis and significant fluid loss, in a patient with associated severe systemic pathology, highlighting the importance of early recognition of TEN, and the role of a multidisciplinary team in providing suitable treatment.

Toxic epidermal necrolysis (TEN) is a rare life-threatening mucocutaneous reaction characterized by epidermal detachment. Treatment success relies on early diagnosis, rapid withdrawal of the causative drug and supportive care. However, clinical evidence for therapeutic management and specific treatment is insufficient and controversial. We describe the successful management of a TEN case secondary to sulfadoxine managed in our intensive care unit. The patient presented a generalized exanthema with mucocutaneous detachment affecting 45% of the body surface area, positive Nikolsky sign, perianal enanthema and conjunctival hyperemia. Treatment with intravenous immunoglobulins and corticosteroids was prescribed, as well as calcium folinate to prevent myelotoxicity of the causative drug. In this case, hemodialysis was dismissed due to the low efficiency of this technique in removing the triggering drug. Our case report confirms the efficacy of corticosteroids, IGIV, topical treatment on mucocutaneous lesions and supportive care for the management of TEN secondary to sulfadoxine.

The neonates are unique in several ways in comparison with older children and adults which render them highly susceptible to severe, sometimes life threatening dermatological disorders. The neonatal dermatological emergencies are a diagnostic and therapeutic challenge. A wide range of dermatoses such as infections, genodermatoses, metabolic disorders and vascular tumors may require emergency care. The clinical presentation also varies from generalized involvement of skin to localized disease with or without systemic symptoms. Irrespective of the etiology and clinical presentation, these disorders are associated with significant morbidity and mortality. With the availability of effective drugs and monitoring facilities, and awareness of need for immediate care, there has been a significant decline in the fatality rate associated with neonatal dermatological emergencies. Knowledge of clinical presentations, rapid diagnostic methods, emergency care and monitoring of progress of the disease helps in comprehensive multidisciplinary care of neonates with these disorders.

The occurrence of eczema herpeticum (EH) in patients with Darier's disease (DD) is a rare occurrence. It is considered a dermatologic emergency due to its high mortality rate if misdiagnosed or left untreated. Here, we present a case of a 42-year-old woman with a longstanding history of DD who presented with EH secondary to herpes simplex 1. Since the incidence of EH is now increasing in adults, we take this as an opportunity to raise awareness among clinicians on the importance of a timely diagnosis of EH and initiating prompt treatment so as to prevent or minimize complications.

Objective: This study aimed to determine the clinical characteristics of the patients admitted to 112 emergency services with dermatological disorders in Kayseri city in 2011. Methods: Data were obtained from the records of Emer­gency Health Care Services Department. Dermatological reasons for calling the 112 emergency services and der­matological cases diagnosed by physicians of 112 emer­gency services were recorded. Kayseri has a population for about 1.25 million. Kayseri 112 emergency services contain 45 physicians, 224 healthcare personnel. Results: In 2011, 2 405 367 calls were occurred in Kay­seri, 112 Emergency Service. Of these calls 920 502 (37.5%) real and necessary calls and the rest 1 484 865 (62.5%) were unnecessary calls. A total of 52472 (5.7% of real calls) cases were determined in real calls. Of the cases, 600 (1.14 % of real calls) patients with derma­tological disorders were observed. The most common dermatological reason for calling the 112 emergency ser­vices was other insect bite (396 calls, 66%) and the most diagnosed dermatological case was other insect bite (396 cases, 66%). Total number of calls about burn were 131 (21,8 %), pruritus were 29 (4.83%), skin wound or infec­tion 18 (3%), bee bite 17 (2.83%), scorpion bite 9 (1.5%). Conclusion: Dermatological disorders in 112 Emergency Service are not rare. Further studies are needed involving the 112 Emergency Service and Emergency Departments in hospitals. J Clin Exp Invest 2013; 4 (1): 47-50 Amaç: Bu çalışmada, Kayseri\\'de 20111 yılında, 112 Acil Servise dermatolojik şikayetlerle başvuran hastaların kli­nik karakteristikleri araştırılmıştır. Yöntem: Bilgiler Acil Sağlık Departmanı\\'ndan alınmıştır. 112 servisi aramaları arasında, dermatolojik hastalıklarla ilgili nedenlerle yapılan aramalar kaydedilmiştir. Sonra­sında, 112 servisinde görevli doktorun tanıları arasında dermatolojik hastalıklarla ilgili olanlar değerlendirilmeye alınmıştır. Kayseri 1,25 milyon nüfusa sahiptir. Kayseri 112 Acil merkezinde 45 hekim ve 224 yardımcı sağlık per­soneli çalışmaktadır. Bulgular: Kayseri\\'de 2011 yılında 112 Acil Servisine 2 405 367 arama yapılmıştır. Bu aramaların 920 502 (37,5%) gerçek ve gerekli aramalar, geri kalan 1 484 865 (62,5%) arama ise gereksiz olarak tespit edilmiştir. Gerçek ara­malarda 52472 (% 5,7) adet klinik vaka tespit edilmiştir. Bu vakalardan dermatolojik hastalık olarak 600 (gerçek aramaların %1,14\\'ü) hasta tespit edilmiştir. 112 Acil ser­vis aramalarında ve tanı konan vakalarda en sık neden; diğer böcek sokmaları (sırasıyla 396 arama, %66 ve 396 tanı %66) olarak bulunmuştur. Yanık nedeniyle aramalar 131 (% 21,8), kaşıntı şikayeti ile aramalar 29 (%4,83) ve deride yara ve enfeksiyon nedeni ile aramalar 18 (%3), arı sokması 17 (%2,83) ve akrep sokması 9 (%1,5) olarak gözlemlenmiştir. Sonuç: 112 acil aramalarında ve tanılarda dermatolojik sorunlar nadir değildir. 112 Acil Servisler ve hastanelerde­ki acil servislerin dahil edileceği yeni çalışmalara ihtiyaç vardır.

Dermatological disease, especially dermatitis and otitis, is a common reasonwhy pet owners seek veterinary care. Emergency clinicians need to be familiar with recent advances in this field since many small animals receive medication and preventives which may impact treatment for other disease or may have led to their visit to the emergency hospital. Additionally, emergency clinicians may be presented with dogs or cats with a primary complaint of pruritus, otitis, or ectoparasites. While most common dermatological diseases are not life‐threatening, secondary pyodermas can result in systemic inflammation and infection. Ectoparasites can not only cause anemia and local dermatopathies, but also spread serious infectious diseases which may be zoonotic.