Although significant progress has been made for the treatment of pemphigus vulgaris (PV) with rituximab (RTX), a consensus remains to be determined for standard treatment protocol, regarding optimal dosing, infusion regimen, and use of concomitant immunotherapy to achieve safe, effective, and rapid clinical response. We describe a patient with pemphigus vulgaris treated with high dose rituximab with the rheumatoid arthritis protocol along with intravenous immunoglobulin therapy. This case provides evidence towards the growing body of research needed to modify and improve treatment for pemphigus using rituximab.

Background: The practice of dermatology remains mainly outpatient, although dermatologic consultations often have a large impact on inpatient care.

Objective: To analyze the reasons for dermatologic consultation and the impact of dermatologic evaluation at a major teaching hospital.

Methods: Retrospective chart review of 243 consecutive dermatologic consultations from primary ward teams between July 2012, and August 2013.

Results: Sixty-seven percent of the dermatologic consults were requested by the internal medicine, intensive care units, and hematology/oncology departments. Common skin conditions accounted for a large majority of consultations including: infectious (24.0%), drug-related (22.3%), and inflammatory skin conditions (21.0%). Most consultations required only one visit for resolution (60.9%). The primary team submitted a correct dermatologic diagnosis in 48.9% of cases. Dermatology consultation resulted in a change in or addition to treatment in 72.4% of patients.

Limitations: Our analysis was limited by the data capture of the consulting physicians and the reliability of the patient historian.

Conclusions: Our results revealed that common dermatoses account for a majority of dermatologic consultations. Modern ward teams continue to struggle with promptly recognizing and appropriately managing common skin conditions. Further training of ward physicians on common dermatologic conditions will improve recognition and treatment of skin conditions in hospitalized patients.