Hospitalist-performed skin biopsy in the diagnosis of skin disease

Abstract

In hospitalized patients, dermatologist intervention can lead to rapid identification and treatment of skin disease. However, many medical centers lack a specialized dermatologist, so skin biopsies might instead be performed by hospitalists. We aimed to determine the impact of skin biopsies performed by hospitalists on the diagnosis of skin conditions. Included in this study were adult patients who had skin biopsies performed for skin conditions by hospitalists at our hospital between 2012 and 2022. We retrospectively analyzed the diagnostic contribution rate before and after skin biopsy. Skin biopsies were performed on 49 patients, with 37 patients (75.5%) having biopsy in one location, 5 patients (10.2%) in two locations, and 7 patients (14.3%) in three locations. The average age was 63.5 [20.2] years, 55% of the patients were male and 12% had an in-hospital dermatologist consultation prior to assessment. IgA vasculitis was suspected in 9 patients (18.4%), and vasculitis, erythema nodosum, and intravascular lymphoma were each suspected in 4 patients (8.2%), respectively. IgA vasculitis was ultimately diagnosed in 10 patients (20.4%), polyarteritis nodosa in 3 patients (6.1%), and erythema nodosa in 3 patients (6.1%). Skin biopsy performed by hospitalists had a diagnostic contribution of 75.5%, with a change in diagnosis of 30.6% and a change in therapy of 14.3%. There was no difference in the rate of treatment changes according to the type of skin condition. Hospitalist-performed skin biopsies are suggested by our results to be limited, but still informative in healthcare facilities without a dedicated dermatologist.