Cutaneous manifestations in patients attending the hematology clinic at King Fahd Hospital of the University during a 13 week-period

Background: Cutaneous disorders are common in patients with hematological diseases especially anemia. Dermatologists usually contribute to the management of these patients in parallel with other medical specialties. Aim: To report common dermatological problems in patients attending the hematology clinic at a secondary care hospital. Materials and methods: The study was conducted at the hematology clinic of King Fahd Hospital of the University during a thirteen week period starting 17th of November, 2013 till 31st of January, 2014. All patients were fully examined and a consultative opinion was given to the attending hematologist. Data sheet was filled and analyzed by SPSS (Statistical Package for the Social Sciences) software version 17.0. Results: 138 patients were seen during the period of 13 weeks. There were 27 males and 111 females. Hemoglobin level was less than 10 gm/dl in 40.6% of patients. The most common reported cutaneous features were diffuse alopecia, hair thinning, pallor, pruritus, fragile skin, easy brusability, dry mouth and gum bleeding in descending frequency. Conclusion: Hematology patients suffered from variable dermatological disorders which suggest the importance of the initial dermatology consultation for those patients as part of their management plan.


INTRODUCTION
Dermatologists play an important role in providing consultative service to other medical specialties.Previous studies have shown that the discipline of Medicine make the most requests for inpatient dermatologic services [1][2][3][4].While most requests for dermatologic consultations are for common skin conditions, challenging scenarios and diagnostic dilemmas are frequently encountered.Skin problems are common in patients with hematological disorders and dermatologist usually add to the management plan of those patients.

OBJECTIVE
To characterize the profile of dermatological issues frequently encountered in patients attending the hematology outpatient clinic at King Fahd Hospital of the University during three months period.

MATERIALS AND METHODS
This prospective cross sectional study was conducted at the hematology outpatient clinic of King Fahd of the University Hospital in Alkhobar, Saudi Arabia during a 13-week period starting 17 th of November, 2013 till 31 st of January, 2014.The Hematology Department in this hospital accepts referrals from other departments and outside hospitals in the Eastern Province also.All patients were fully examined by a consultant dermatologist with assisting interns trained by the dermatologist.Data sheet was filled for each patient with documentation of age, gender, associated conditions and all observed cutaneous lesions.Data was entered in the computer and analyzed by SPSS (Statistical Package for the Social Sciences) software Version 17.0.
None of the patients had a skin biopsy because a clinical diagnosis was deemed sufficient.There was other associated medical conditions in some patients including hypertension, diabetes mellitus, hepatitis c, liver cirrhosis, gastritis, dyslipidemia, hypothyroidism, congenital adrenal hyperplasia, acne vulgaris, discoid lupus eruthematosus and psoriasis.

DISCUSSION
Cutaneous problems are common in patients with anemia.Unfortunately no similar study was previously conducted in Saudi Arabia to compare it.However, the study reveals the importance of  internist, hematologist and dermatologist in the management of patients with anemia.In a random review of patients admitted to a Hematology-Oncology unit, Pearson et al found mucocutaneous disorders in 88% of cases seen.The most common findings in their study were alopecia, mucositis, palm and sole erythema [5].In another similar study done by Hy Koh in Singapore [6], 692 patients were referred for primary dermatological issues during six months period.This is implies that non-dermatologists face difficulties diagnosing common dermatoses [1,4,[7][8][9][10].Besides, a dermatologic consultation resulted in changes in diagnosis and management in 60% to 77% of the cases [1,8,10], which highlights the importance of dermatologic education of the consulting physicians regardless of his specialty [11].Our findings in this study highlights the importance of the involvement of the dermatologist in the management of hematology patients through initial consultation as part of their general management plan.

7 Figure 1 :
Figure 1: Variable skin, nail and hair changes in our patients.A. Dermatitis and severe dryness.B. Brittle nail with super imposed fungal infection.C. Nail Clubbing.D. Diffuse alopecia D C

Table 1 :
Percentage of some of the reported cutaneous conditions found our patients