Pattern of admissions to a tertiary dermatology unit in South Africa

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.

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.

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.

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.

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.