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Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre

Thomas Jovic, Rebecca Watson Orcid Logo, Sarah Hemington Gorse, Peter J. Drew, Jonathan J. Cubitt

Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume: 88, Pages: 352 - 359

Swansea University Author: Thomas Jovic

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DOI (Published version): 10.1016/j.bjps.2023.11.009

Abstract

Introduction: This study sought to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expense associated with caring for these patients within the burns service.Methods: Patient records were identified with non-burn induced ski...

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Published in: Journal of Plastic, Reconstructive & Aesthetic Surgery
ISSN: 1748-6815
Published: Elsevier BV 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65087
Abstract: Introduction: This study sought to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expense associated with caring for these patients within the burns service.Methods: Patient records were identified with non-burn induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, dressing clinic records. A cost analysis was conducted using figures from the National Schedule of National Health Service Costs and our own unit-specific costs.Results: 20 patients were identified, with a median age of 46.5 and median TBSA of 30%. The mean length of stay was 21.2 days with 8/20 patients requiring intensive care. Overall mortality was 30%, rising to 50% if patients required ITU admission. Patients had a mean of 1.5 procedures under general anaesthesia and a mean operative time of 169 minutes per patient. Post-operatively, a mean of 8.3 dressing changes were required per patient (range 1-21). 75% of patients were referred as suspected toxic epidermal necrolysis syndrome (TENS) yet, only 32% of patients histologically had TENS (32%), with linear IgA disease, pemphigus vulgaris, and bullous lupus comprising the other diagnoses. Cost analysis predicted a total cost to the unit of £1,422,106.Conclusion: Desquamating dermatological diseases are life-threatening conditions with exhaustive care requirements. Our experiences highlight the importance of awareness of the range of desquamating skin conditions beyond TENS to enable optimum management, and the need to ensure adequate financial provisions to accommodate the care requirements mandated by these patients.
Keywords: Burns, desquamation, dermatology, service provision
College: Faculty of Medicine, Health and Life Sciences
Funders: Action Medical Research/ the VTCT Foundation (GN2782) and the Scar Free Foundation/Health and Care Research Wales.
Start Page: 352
End Page: 359

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