title: The impact on resources of prevalence and nature of skin problems in a modern intensive haemato-oncology practice.
abstract: We undertook a randomised prospective observational study to identify the true prevalence of dermatological problems on an acute in-patient haemato-oncology unit treating patients with myeloma and leukaemia (median age 52 years), that could be used to plan for optimum dermatological servicing of such a unit. As a snap-shot, beds were randomly selected each week and the patients in them examined to identify the prevalence and identity of mucocutaneous problems for in-patients. Primary endpoints were the prevalence of integument reactions, prevalence and type of rash. Eighty-four leukaemia and myeloma patients were seen on 200 episodes. Integument changes were seen in 88% of episodes. Predictable changes such as hair loss (74%) and mucositis (38%) were seen commonly. Rashes were seen in 38% of episodes. The most common rash was palm and sole erythema (10% of all episodes) which was associated with allogeneic BMT (20%; p=0.0009). Flexural erythema with subsequent desquamation occurred in 4% of episodes, more commonly in males (p=0.09). Drug allergies were seen in 14 of 200 episodes and were significantly associated with antibiotics (p=0.003). Patients' perceived their skin problems as moderate or severe in 19% of the episodes. The impact on resources in the haematology practice was large; 45% of inpatients were receiving topical or systemic skin treatment, in 5% of patients the oncology treatment was compromised, 11% of patients required extra nursing and 3% of patients stayed longer in hospital. This volume of mucocutaneous problems makes dermatological input to haemato-oncology units vital.
authors.affiliation: Royal Marsden NHS Trust and Institute of Cancer Research, Surrey, UK. ianpearson@doctors.org.uk
authors.forename: Ian C
authors.initials: IC
authors.lastname: Pearson
authors.forename: Bhawna
authors.initials: B
authors.lastname: Sirohi
authors.forename: Ray
authors.initials: R
authors.lastname: Powles
authors.forename: Jennifer
authors.initials: J
authors.lastname: Treleaven
authors.forename: Peter S
authors.initials: PS
authors.lastname: Mortimer
mesh_terms: D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007938:Leukemia / Q000150:complications*; D008297:Male; D008545:Melanoma / Q000150:complications*; D015995:Prevalence; D012871:Skin Diseases / Q000453:epidemiology* / Q000209:etiology