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Introduction: Although dermatologic conditions bring relatively few people to the Emergency Department, hospitalized patients, especially older people, often suffer from skin problems that contribute to their morbidity., Aims: We wanted to identify the frequency, clinical course, treatment and influence on hospitalization of dermatologic conditions in patients hospitalized in internal and geriatric departments in Galilee Medical Center. We concentrated on two groups of adults, aged 40-65 years (adult group) and above 65 years (elderly group), in order to understand differences in the cause of referral, type of diagnosis and mode of treatment., Methods: We performed a retrospective review of 82 hospitalized patients who were referred for dermatological consultation between May-September 2013. Of the 82 patients, 47.6% made up the 'adult' group and 52.4% the 'elderly' group; 62.2% of patients were independent, 18.3% partially independent and 19.5% needed nursing care., Results: Skin infections (38.3%), allergy (mostly drug induced) (23.5%) and trophic disorders (18.5%) were the most common diagnoses. 'Elderly' were less often referred to dermatological consultation than 'adults' (44.3% vs. 55.7%, respectively); skin infections were more common in the 'elderly' (44.8% vs. 55.7%). Nursing care patients (19.5%) were least referred to dermatological consultation, but severity of skin condition (the number of diagnoses and number of treatments per patient) was greater in nursing care patients., Conclusions: The clinical course between the independent and nursing care patients varies in the number of requests, the different type of diagnoses, the severity of the conditions and the number of treatments provided., Discussion: Our study emphasizes the importance of skin examination by a dermatologist, considering the high number of referrals for dermatological consultations. On the other hand, there was a significant difference between the 'elderly' and 'adult' groups, with fewer referrals for dermatological consultations by the medical staff in the 'elderly' group. Our results resemble those in the literature, having identified the most common skin problems in two groups of hospitalized patients.

The diagnosis of bite by the brown recluse spider, Loxosceles reclusus, is rarely based on absolute identification of the insect because the victims are usually bitten while sleeping or dressing. More often, the history, clinical findings and course of the bite lead to the diagnosis. For early confirmation up to 24 hours after the bite, the passive hemagglutination test can be used. For older lesions, the in-vitro lymphocyte transformation test is useful, but is available in only a few medical centers. Treatment of the bite of the brown recluse spider varies from conservative to more active approaches. Resting, local cooling, systemic antibiotics to prevent infection and mild anti-inflammatory drugs may be given. In the more active approach oral corticosteroids are added in the first 72 hours to the antibiotics, especially in massive bites with necrotic centers greater than 2 cm in diameter, or when there is systemic loxoscelism. Recently, good results have been reported with Avlosulfon (dapsone), which is claimed to cure necrotic cutaneous ulcerations, presumably by reducing the activity of polymorphonuclear leukocytes. Other treatments include specific antivenin, (of limited use because it must be administered shortly after the bite), and surgery to prevent spreading of the venom. We describe 3 cases of brown spider bite with typical clinical presentations in adults aged 20-40 years. 2 were treated with corticosteroids and antibiotics and 1 with Avlosulfon and prednisone, all within 72 hours of the bite. 2 recovered completely within a few days, but the third treated with prednisone and antibiotics, developed an ulcer which healed only after several months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)