Introduction Although the practice of dermatology has recent

Introduction Although the practice of dermatology has recently become a predominantly outpatient-based specialty, there continues to be a need for dermatological expertise within hospitals, where patients have a wider spectrum of severe and serious dermatological disorders associated with significant morbidity. Many patients who are admitted to hospital for various nondermatological diseases often have underlying skin disease, whereas others develop acute dermatological problems during their stay in hospital. These general illnesses contribute to developing and worsening the primary dermatological diseases; the management of an underlying disease can also cause dermatological disease. Several recent studies have independently shown that our skin is an unexpectedly prominent target organ for numerous neuroendocrine, neurotrophic, neurotransmitter, and neuropeptide signals, which have a profound effect on skin biology in health and disease. The aim of this study was to characterize the profiles of patients with corticotropin releasing factor damage and the scope and referral pattern of dermatology consultations in a tertiary hospital, which has not previously been well studied.
Patients and methods All consultations with patients in hospital were referred to the Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, between 1 January, 2007 and 31 December, 2011. The data were collected retrospectively from the admission and daily progression notes provided by the attending doctor and the consultation notes made by the dermatological consultant. Final diagnoses were classified according to the English version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Only the dermatological disorder responsible for the consultation was recorded. During weekdays, each request was allocated to one of three different dermatology consultants, assisted by a 3rd-year dermatology resident. A potassium hydroxide smear test from skin scrapings, swabs for bacterial culture, and biopsy samples were taken as appropriate by the dermatologist to reach a definitive diagnosis. The severity of brain damage was classified into three groups (severe, moderate, and mild) based on the Glasgow Coma Scale (GCS) and these scores were evaluated by the attending doctors. All statistical analyses were performed using SPSS 12.0 (SPSS Inc., Chicago, IL, USA). Absolute and relative frequencies were analyzed for all data. Continuous variables, such as age, were expressed as mean values with standard deviations. The difference in the prevalence of skin disease according to the GCS score was evaluated by the Chi-square test. In all instances, p < 0.05 was considered significant.
Discussion The dermatological diseases of patients with brain damage are often overlooked during their period of admission to hospital because of many other complicated medical problems. Patients with brain damage have difficulty in describing their symptoms because of an alteration in consciousness, and this tends to delay diagnosis. However, we should also consider the fact that the opportunity to develop dermatological problems is relatively high in patients with brain damage. Decreased movement, altered immunity, and long-term stays in hospital provide suitable conditions for the growth of microorganisms, and treatment with antibiotics or aromatic anticonvulsant drugs (e.g. carbamazepine, phenytoin, phenobarbital, primidone, and oxcarbazepine) can cause severe adverse drug reactions. In particular, a recent study has shown that the central nervous system and the skin are connected by various mechanisms. The fact that the skin and nervous system develop from the same embryological origin, share common molecular syntax, and communally utilize the immune system to provide signals and regulation, is generally acknowledged. The central nervous system is directly or indirectly connected to the functioning of skin. The direct connection is via efferent nerves or mediators derived from the central nervous system, and the indirect connection is via the adrenal glands or immune cells. We thus speculate that damage of the central nervous system can contribute to the development of dermatological diseases.