# Dermatological Presentations in the Adult Emergency Department: A Retrospective Audit of Frequency, Management, and Outcomes in a UK Tertiary Centre

## TL;DR

This study examines how dermatological conditions are managed in emergency departments, finding inconsistent care and a need for better protocols and training.

## Contribution

The paper provides an audit of dermatological cases in an ED, identifying gaps in guideline adherence and suggesting the need for local protocols and education.

## Key findings

- Allergic reactions and cellulitis/abscess were the most common dermatological diagnoses in the ED.
- Only 6.3% of patients received dermatology follow-up, and 37.5% had no documented follow-up.
- Management of dermatological cases was inconsistent with national guidelines, highlighting a need for improved training and protocols.

## Abstract

Background

Dermatological conditions frequently present to emergency departments (EDs), ranging from benign rashes to severe immunological emergencies. However, most ED clinicians receive little or no formal dermatology training, leading to variation in management and incomplete documentation, particularly of drug history and follow-up planning. In the absence of standardised referral pathways or local ED dermatology protocols, the quality of care is inconsistent and may not align with national standards.

Objective

To evaluate the frequency, diagnostic categories, management, and clinical outcomes of dermatology-related presentations to the adult ED. The audit aimed to assess compliance with national guidelines and determine whether the observed gaps highlight the need for a structured local dermatology protocol and standardised referral pathway.

Methods

A retrospective audit was conducted at a tertiary ED over a three-month period (March-June 2025). Data for 80 patients were extracted from electronic records. Variables included demographics, clinical diagnoses, treatments administered, investigations performed, comorbidities, and disposition outcomes. The audit was benchmarked against National Institute for Health and Care Excellence (NICE) and British Association of Dermatologists (BAD) guidelines.

Results

Of 80 patients, 60% were female, and the mean age was 42 years (range 8-95). Allergic reactions (23.8%) and cellulitis/abscess (20%) were the most common diagnoses. Blood tests were performed in 61.3% of patients; 60% received treatment. Antibiotics (20%) and antihistamines (12.5%) were commonly used. Dermatology follow-up occurred in only 6.3% of cases. A total of 21 patients (26.3%) were admitted, while 37.5% had no documented follow-up. Documentation of drug history was inconsistent.

Conclusion

Dermatological cases are a frequent and varied component of ED workload, but are not consistently managed according to guidelines. The findings highlight the impact of limited dermatology training on documentation and management, and demonstrate the need for a local dermatology protocol, improved education for ED staff, and standardised follow-up pathways.