As you do your rounds in the hospital, it could prove beneficial to consult with patients regarding any skin-related concerns they have. Also, as a hospitalist, it’s important that you examine patients for skin-related conditions.

“The skin can be a window into systemic condition,” said Jeffrey Weinberg, MD, clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York City. “The skin can provide evidence of an underlying condition from which the patient may suffer.”

How Can a Hospitalist Take Action?

A hospitalist should manage issues that are mild to moderate and that can be conservatively addressed, according to Weinberg. “Certainly, if the skin is dry, they should recommend moisturization,” said Weinberg. “If anything else is observed that is a higher concern or may be more complicated, dermatology consultation should be initiated.”

Weinberg mentioned these conditions to consider: 

• A rash associated with fever and/or chills
• Diffuse blisters that are painful and peeling
• A new growth
• One or multiple ulcers on the skin
• Corruption that covers a majority of the body

Making observations and asking patients about symptoms and timing provide valuable clinical information. “Hospitalists can reassure the patient that this is just for informational purposes and not because there is any alarm,” Weinberg said.

Factors That Cause Patient Itchiness

If a patient complains about itchiness, a further assessment is advised. It could be related to inpatient surroundings or because of another medical condition.

“That said, itching, of course, can be associated with systemic illness, such as diabetes, thyroid conditions, liver disease, and kidney disease,” said Whitney A. High, MD, JD, professor of dermatology and pathology at the University of Colorado School of Medicine in Aurora, Colorado. 

High said it is useful to divide itching into two categories: itching with rash and itching without rash. Physicians can manage “itching with rash” via strategies like withdrawal of any offending agents, skin moisturization, topical steroids, and oral antihistamines, according to High. “Itching without rash” can be due to perturbations of homeostasis, such as diabetes, renal disease, or liver disease, and may be more slowly responsive to therapy, High said. 

Understanding the Causes and Consequences of Bedsores

Bedsores are injuries to the skin and soft tissue caused by unhealthy and prolonged pressure. Such sores develop in hospitalized patients due to immobility or being unable to sense pressure, according to High. “Bedsores both prolong the patient’s hospital stay and increase the risk of infection,” he said.

Means to lessen the risk for bedsores include using special mattresses and cushions in immobile patients and requesting that nurses monitor, track, and mitigate against pressure injuries by changing patient positions every 2 hours, keeping skin clean and dry, and getting patients up and out of bed when possible, said High.

Sharing Your Concerns With the Medical Team

If the hospitalist is concerned about skin-related symptoms reported by the patient or signs observed during examination, they should bring these concerns to the attention of the patient’s primary provider and suggest consideration of a dermatology referral.

Practical Interventions: Hospitalist Recommendations for Patients

• Using moisturizer
• Drinking more fluids
• Making sure gowns fit correctly
• Encouraging patients to get out of bed or have positions changed

“The skin stays better hydrated when plenty of water is [consumed], assuming that the patient is not on any type of fluid restrictions,” said High. “And changing positions at least every 2 hours and getting out of bed are also wise ideas to prevent bedsores.” 

Why Is Skin Monitoring Particularly Important?

The skin is a large organ covering the whole body. “It can be used to assist in the diagnosis of other underlying conditions,” said Weinberg. “It can also be a location in which additional problems arise. Therefore, careful examination and monitoring is in the best interest of patient care.”