Inpatient Dermatology Consult Note

Note type: [Initial consult / Follow-up consult] | Date: [Date] Time: [Time]

Requesting service/clinician: [Requesting service and clinician name/role] | Patient location: [Unit/Room]

Sources of history: [patient / family / chart / bedside nurse / interpreter] (If interpreter used, include language and ID. If history limited, briefly state reason and alternate sources used.)

Reason for Consult

[Consult question in primary team's words] | [present on admission / hospital-acquired] (Note urgency flags if present: mucosal involvement, bullae, skin pain, purpura/necrosis, hemodynamic instability. Keep to 1–3 lines.)

Clinical Summary

[One-sentence orientation: age, relevant immunologic status, key comorbidities, rash duration, salient morphology/distribution, and key systemic features] (Use full words without abbreviations.)

History of Present Illness

[Narrative description of onset date/time, evolution, symptoms (pruritus, pain/burning, tenderness, swelling), initial anatomic site and progression/symmetry, prior similar episodes, treatments tried and responses, relevant inpatient exposures/events (procedures, lines, dressings, contrast, new antibiotics, transfusions, ICU events). Conclude with key discriminators such as skin pain out of proportion, mucosal symptoms.] (If history unobtainable, explicitly state why and summarize alternate sources.)

Medication and Exposure History

(For each medication, include start date, stop date if applicable, indication, and prior tolerance. If dates unknown, write "start date unclear" and specify source limitation. Do not guess. Prioritize antibiotics, anticonvulsants, allopurinol, NSAIDs, proton pump inhibitors, diuretics, checkpoint inhibitors, biologics.)

• New/systemic medications in last 2–8 weeks:
  • [Medication] — [start date] [stop date if applicable]; [indication]; [prior tolerance: yes / no / unknown]
• PRN medications administered: [Drug, dose, route, administration dates/times] (Document medications actually given, not just ordered.)
• Over-the-counter, supplements, herbals: [List with start dates if known]
• Topical and device exposures: [Antiseptics, adhesives, dressings, incontinence products, emollients with application sites and start dates]
• Infectious epidemiology: [Sick contacts / unit outbreaks / recent travel / animal exposures with dates if relevant]
• Prior drug eruption history: [Culprit, reaction type, timing, severity, treatment required]

Relevant Background

(Include only problem-relevant history.)

• [Immunosuppression status: medications, transplant, neutropenia, HIV with relevant labs]
• [Autoimmune disease / atopy / psoriasis / prior bullous disease / vasculitis]
• [Recent infections relevant to differential (HSV, Mycoplasma-like illness, viral syndromes)]

Review of Systems

(Document positives and high-value negatives for each category.)

• Mucosal: [oral pain / odynophagia / eye pain or photophobia / genital erosions]
• Systemic/organ: [dyspnea / hematuria / abdominal pain / arthralgias / facial edema]
• SCAR clues: [skin pain / facial edema / fever / lymphadenopathy]
• Infection clues: [sore throat / cough / diarrhea]

Objective

Vitals and General

[Temperature, blood pressure, heart rate, respiratory rate, oxygen saturation] (Include date/time if trend-critical.)

[General appearance: toxic vs non-toxic; level of distress; mental status if relevant]

Skin Examination

Scope of exam: [total body / focused] (State reason if limited: patient declined, unstable, isolation.)

• Primary morphology: [macules / papules / plaques / vesicles / bullae / pustules / wheals]
• Secondary changes: [scale / crust / erosion / ulceration / excoriation / necrosis]
• Modifiers: [color, shape, border, palpability, blanching vs non-blanching, tenderness, warmth]
• Configuration: [annular / linear / retiform / targetoid / grouped / follicular]
• Distribution: [anatomic sites, symmetry, acral vs truncal, dependent areas, intertriginous, dermatomal]
• Extent: [% BSA involved] (If vesiculobullous/erosive, document % epidermal detachment separately.)

Findings by region: (Use morphology-first description for each region examined; omit regions not examined.)

• Scalp/Face/Neck: [Lesion morphology, distribution, modifiers]
• Trunk/Back: [Lesion morphology, distribution, modifiers]
• Upper extremities: [Lesion morphology, distribution, palms/nails involvement]
• Lower extremities: [Lesion morphology, distribution, soles involvement, edema]
• Intertriginous areas: [Axillae, inframammary, groin, perineum findings]
• Mucosae: [Conjunctiva / oral / genital] (Explicitly document presence or absence of mucosal involvement.)

High-acuity features: (Document when clinically relevant; omit if not applicable.)

• [Nikolsky sign: positive / negative / not assessed]
• [Skin pain severity and location]
• [Bullae/erosions: distribution and % detachment estimate]
• [Purpura: palpable vs non-palpable; retiform pattern; ulceration/necrosis]

Synthesis: [Concise summary of key morphology, distribution, extent, and mucosal/systemic involvement]

Clinical Photographs

[Photos obtained and stored per institutional policy on date/time.] (Include only if photos were obtained; otherwise omit this subsection entirely.)

Data Reviewed

• Laboratory data: [CBC with differential and absolute eosinophil count, CMP/LFTs, inflammatory markers with dates and trends]
• Microbiology: [Blood/wound/tissue cultures with collection dates and results]
• Pathology: [Prior biopsy results with site, date, key histologic findings]
• Imaging: [Relevant imaging and findings with dates]
• MAR highlights: [Key administered medications with dates/times relevant to eruption timing]
• Pending: [Pending tests/specimens with rationale and expected turnaround] (Omit if none pending.)

Assessment

Impression

[Working diagnosis or leading diagnostic category]. Severity: [mild / moderate / severe]. [Key features supporting impression and features arguing against top alternatives.] (3–8 sentences.)

Problem List

1. [Problem 1 – consult reason first; use morphology-based descriptor if diagnosis uncertain]
2. [Problem 2]
3. [Additional problems as applicable]

Differential Diagnosis

(Include when diagnosis is uncertain or high-stakes conditions must be excluded. Include only morphology categories relevant to the presentation. For each candidate, note supporting features, features against, and tests to clarify. Label medications as "possible culprit" unless timing, known association pattern, and exclusion of alternatives are clearly documented.)

• [Relevant morphology category]: [Candidate diagnoses with supporting/against features; tests to clarify]

Plan

1. [Problem 1]:
   • Diagnostic: [Labs, cultures, biopsy type/site/number with rationale, imaging, additional consults]
   • Therapeutic: [Topical/systemic treatments with dose, route, frequency, duration, monitoring parameters]
   • Medication management: [Stop/avoid/continue recommendations with rationale; "do not rechallenge" guidance; allergy list update instructions]
   • Supportive care: [Skin/wound care, pruritus control, pain management, emollients, dressings]
   • Monitoring: [Parameters to watch: mucosal progression, skin pain, hemodynamics, lab trends; escalation triggers]
   • Follow-up: [Timing of dermatology re-evaluation; outpatient needs]
2. [Problem 2]: [Repeat structure as applicable]

High-Acuity Considerations

(Include only if any of the following are present: bullae/erosions, skin pain, mucosal involvement, purpura/necrosis, facial edema with fever, hypotension, rapid progression. Otherwise omit this subsection entirely.)

• Level of care: [Recommendations for higher level of care / burn or ICU consideration]
• Immediate medication actions: [Urgent discontinuation of suspected culprits; alternatives]
• Subspecialty coordination: [Ophthalmology for ocular involvement; ENT for airway/oral involvement; burn/wound care; others as indicated]

Biopsy Plan

(Include when biopsy is recommended. Otherwise omit this subsection entirely.)

• Purpose: [Rule out vasculitis / autoimmune blistering disease / infection / SCAR / other]
• Specimen plan: [H&E site and lesion selection rationale; DIF site and handling requirements; tissue culture if indicated]
• Procedure coordination: [Who will perform; timing; patient factors such as anticoagulation or thrombocytopenia]
• Anatomic site: [Exact location, morphology, and age of lesion selected]

Communication and Follow-up

Recommendations communicated [verbal / phone / secure message] to [name and role] at [date/time]. [Key actions implemented or pending confirmation.]

Dermatology follow-up: [Inpatient re-evaluation timing] | Outpatient needs: [Clinic referral timing and indication] | Pending results responsibility: [Service/clinician who will follow and act on results]