Prevalence of cutaneous findings in hospitalized medical patients

Cutaneous signs may represent a systemic process or a primary cutaneous disorder. Prompt observation and identification of cutaneous abnormalities should improve care of hospitalized medical patients.

Our purpose was to determine the prevalence of cutaneous abnormalities in newly hospitalized medical patients and the frequency with which these findings were noted by the admitting team.

All new medical patients were offered a complete skin examination within 48 hours after admission to the hospital, and 231 participated. Cutaneous diagnoses were based on characteristic clinical features or skin biopsy in patients in whom a diagnosis could not be made clinically.

Ninety-three cutaneous findings were present in 83 (35.9%) of 231 patients. In 31 (13.4%) we found cutaneous signs related to the reason for hospitalization or associated with a systemic disorder. These were not noted by the admitting medical service in 14 patients. In two patients, one with metastatic adenocarcinoma and one with sclerosis, the cutaneous findings were manifestations of the new diagnosis. In 52 patients (22.5%) we found 62 primary cutaneous disorders. Fifty-eight disorders (93.5%), including 10 nonmelanoma skin cancers, were unrecognized at the time of admission.

Cutaneous findings representative of systemic disease or primary cutaneous disorders are commonly present and frequently overlooked in medical patients newly admitted to the hospital. These data suggest that a complete skin examination is necessary in all newly hospitalized medical patients.