It may commonly been remarked that dermatology is usually considered as an outpatient specialty associated with low mortality . This notion could lead to less dermatological attention given to hospitalized patients by some of their attending physicians. Less dermatologic attention paid to admitted patients may allow most of the skin diseases to run a chronic course with significant effects on the general health as well as the quality of life of the affected individual.
Certain systemic disorders can be suspected through cutaneous symptoms and signs. This hospital-based cross sectional study has described the magnitude of co-existing dermatological disorders among patients admitted to medical wards of a national consultant hospital. Almost all forms of skin diseases (infectious, non-infectious, neoplastic, non-specific rashes) were encountered although at different frequencies. When specific types of dermatological disorders were analyzed, the most common were fungal infections (18%), bacterial infections (7.1%), and viral infections (5.3%). Many community based studies conducted in developing tropical countries have described infectious dermatological disorders, especially fungal and bacterial infections as being the most commonly encountered [1–3, 11].
The pattern of co-existence between dermatological and other medical conditions in our study demonstrated that, over three-quarters of patients with PPE, seborrheic dermatitis, oral candidiasis, cutaneous warts and psoriasis had HIV/AIDS. On the other hand, all patients with Kaposi's sarcoma (11/11; 100%) were HIV infected. HIV infection has been reported to cause its greatest impact on the skin whereby, today over fifty different types of HIV-related skin diseases have been documented [14–16]. Various studies on HIV related mucocutaneous manifestations conducted worldwide, have documented HIV related skin diseases as being very common [14–17]. In this study it has also been observed that, a wide variety of systemic diseases co-existed with dermatological conditions. Systemic diseases which demonstrated high frequency of dermatological disorders (>50%) included diabetes mellitus, chronic kidney disease, hematological disorders hepatic diseases and neurological diseases.
The finding of cellulitis in only 1.5% of admitted patients in our study, while cellulitis tends to be one of the frequent causes of admission in developed countries may not be surprising since in our set up, mild forms of cellulitis would normally be managed at peripheral hospitals while severe cellulitis which is usually associated with dermal necrosis and fasciitis would be admitted to surgical (and not medical) wards for surgical interventions such as surgical toilet, slouphectomy and even skin grafting.
The prevalence of dermatological disorders at pre-admission (referral) and admission periods, was grossly underestimated for all disorders except for Kaposi's sarcoma which was over-diagnosed. Most skin diseases were overlooked by the referring and admitting doctors. In many areas, health professionals have been reported as being unaware of the burden of dermatological diseases . Health workers tend to overlook or even ignore skin diseases despite the fact that some of them form important signs or symptoms of the underlying internal diseases. This apparent 'unawareness' attitude has been partly attributed to inadequate knowledge of dermatological disorders among clinicians . On the other hand, it could also be speculated that the majority of patients presenting to hospitals for various diseases, may not complain about their accompanying dermatological problems (which would have enabled clinicians to easily detect them), probably due to the assumption that skin diseases are a mere cosmetic nuisance, not associated with any serious suffering. All these factors may lead to delays in diagnosing the underlying serious and even life threatening systemic diseases.