The value of in-patient dermatology: a survey of in-patients in Scotland and northern England

Dermatology in-patient units are frequently threatened with reduction or cl osure, yet there are few objective data regarding the nature and use of in- patient management with which to assess their value, We have surveyed 300 p atients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social, profile, and the outcome of admission. All departments provided phototherapy and but-pa tient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted princi pally because of disease severity but many, including half of those with ps oriasis, had concurrent medical problems Such as alcohol abuse, psychiatric disorder or arthropathy. Many patients willi psoriasis and leg ulcers were from socially:deprived areas, as defined by low Carstairs index scores, an d a: similar proportion received income support. Eighteen per cent of patie nts, mainly those with acute. disorders, would have needed admission irresp ective of dermatology bed availability. Out-patient management was consider ed the next best alternative for-only 28% of patients, and many patients wo uld have been expected to treat themselves. By Contrast, 84% of patients ad mitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particul arly good in psoriasis, eczema,and infection groups. We have demonstrated t hat in-patient management is highly effective in providing remission in chr onic skin disease, and:our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.