Dermatologic Emergency Unit Has High Rate of Nonemergency Presentations

sliding doors in the front of an emergency department
What causes patients to present to a dermatologic emergency unit, and what kind of referrals do they receive?

Localized skin redness and painful skin condition are the leading reasons patients present to a dermatologic emergency unit (DEU). And most patients do not have actual emergencies, investigators reported in the Journal of the European Academy of Dermatology and Venereology.

The researchers administered a questionnaire to patients who presented to the DEU of Henri-Mondor Hospital in Paris, France, from August 1, 2017, through August 31, 2017. The survey included questions regarding the reasons for their visit as well as patient characteristics. The study authors compared the characteristics of patients who needed a hospital referral (hospitalization, follow-up, day care hospital) with those who did not.

A total of 1626 patients (median age, 42 years; range, 14-103) consulted the DEU in the study period, and 97% responded to the questionnaire; 1561 questionnaires were included in the analysis. Of the 344 patients who needed a hospital-based referral, 0.38% required hospitalization.

Patients who needed a hospital-based referral were more frequently addressed by physicians (110/344 vs 282/1217, P < 10–3) and were 75 years of age or older ((45/344 vs 62/1217, P < 10–3 ) compared with those who did not. Patients who needed a hospital-based referral also had more chills (39/344 vs 82/1217, P = .01) and more generalized redness (55/344 vs 145/1217, P = .05), as well as significantly less localized redness (139/344 vs 605/1217, P = .03).

Localized skin redness was the most frequent reason for presenting to the DEU, and painful skin condition was the second most frequent cause.

Most referrals after a DEU visit were non–hospital-based, which is comparable to the high percentage of discharged patients (87.1%) who present to the general emergencies unit for a dermatologic condition, noted the study authors. Older age, chills, generalized redness, and referral status may be predictive of a higher severity and require a second hospital event.

“Most patients presenting to the DEU neither have real emergencies nor require hospital referrals,” the researchers commented. “A structured triage pathway is thus needed. Teledermatology can also be a useful tool to decrease the high rate of [non-emergency] presentation to the DEU.”


Skayem C, Labonnelie A, Fardet L, et al. Which patients present to dermatologic emergencies? A survey on 1561 patients. J Eur Acad Dermatol Venereol. Published online April 23, 2021. doi:10.1111/jdv.17298