Dermatology Consults Improve Follow-Up Care in Acute Care Management of HS

Dermatology consultations for individuals with hidradenitis suppurativa (HS) in emergency and inpatient settings improve follow-up care substantially, new data suggest, frequently leading to shifts in management plans.1

Such findings represent the conclusion of a recent letter to the editor, authored by such investigators as Steven T. Chen, MD, MPH, an associate professor of dermatology at Harvard Medical School. Chen led a team of investigators in this analysis, seeking to assess the role of dermatology consultation in HS management.

Chen and coauthors highlighted the existence of certain guidelines in place for HS management within acute care settings, though they also noted the lack of information about the role that dermatology consultations can play in such settings.

“Previous studies have consistently highlighted the important contribution of dermatology consults in enhancing inpatient care for a variety of dermatologic conditions,” Chen et al wrote.1,2 “To that end, we aimed to evaluate the role of dermatology consultation in the management of HS in the acute care hospital setting.”

Study Design and Findings

The investigators utilized data drawn from the Mass General Brigham Research Patient Data Registry, seeking to identify all encounters with patients wherein HS was listed as the primary diagnosis. This was done across 9 hospital sites in the timeframe between December 2019 - December 2023.

The team used a manual review of the medical charts, confirming HS as the main reason for each patient's encounter. Chen and colleauges sought talsoo capture any information related to the primary team’s diagnosis and treatment plan, study subjects' dermatology consultation status, dermatology team recommendations, and any plans related to discharge, including follow-up arrangements.

Altogether, the investigative team recorded 259 encounters among 198 unique patients. This would involve a total of 212 emergency department visits as well as 47 inpatient admissions. Documentation of dermatology consultations took place in only 60 of these encounters, or 23.2% of the total. The team highlighted the likelihood of receiving a dermatology consult as not shown to be impacted by demographic or socioeconomic variables such as sex assigned at birth, age, race, type of insurance, or ethnicity (P> .05 for all).

HS severity evaluations were noted by the investigators as not feasible given inconsistent documentation across available charts. In their assessment of care outcomes, follow-up with dermatology following discharge was noted as having taken place significantly more often when a consult had taken place. Specifically, Chen et al reported 98.3% of those within the consult arm were given follow-up appointments, as opposed to only 30.7% within the non-consult arm (P< .001).

The investigators further highlighted findings among the encounters that involved dermatology consultation, noting management changes had been advised in 54 cases (90%). Most modifications were found to be updates to antibiotic and corticosteroid regimens or supportive care measures, while new biologic therapies were initiated in 12.9% of cases.

Study limitations acknowledged by the team included the analysis's retrospective, single-center design and dependence on medical record review, which restricted accurate evaluation of HS severity due to variable documentation. Additionally, the study focused on encounters for patients with pre-existing HS and did not assess whether dermatology involvement reduced time to initial diagnosis—a key challenge in improving HS care.

Overall, Chen and coauthors' conclusions pointed to the effectiveness of dermatology consultations in both inpatient as well as emergency care settings. They noted significant enhancement of HS management as a result of such consultations, with modification rates similar to or slightly exceeding those reported in general inpatient dermatology literature. Improved follow-up care with patients may result from streamlined referral systems. They also credited the improved patient engagement with dermatology along with better adherence to post-discharge care plans.

“Future studies should evaluate if dermatology consultation and subsequent changes in management reduce length of stay, reduce readmission rates, and aid controlling overall disease activity," Chen and colleagues concluded.

They also noted the likelihood of a role for piloting pathways within emergency room settings, given the need to bridge acute and chronic management of HS.

References

1. Baker N, Hijaz B, Chen ST. Impact of Dermatology Consult on Inpatient and Acute Care Management of Hidradenitis Suppurativa. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70198.

2. Ko LN, Garza-Mayers AC, Kroshinsky D, et al. Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis: A Randomized Clinical Trial. JAMA Dermatol. 2018 May 1;154(5):529-536. doi: 10.1001/jamadermatol.2017.6196. PMID: 29453872; PMCID: PMC5876891.