Skin Rashes in Emergency Department Visits, Clinical Features, Differential Diagnoses, and Admission Rates: A Systematic Review

Abstract

Objective: To systematically review the epidemiology, clinical features, differential diagnoses, and outcomes of dermatological conditions presenting to emergency departments. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between 2011 and 2024. Eligible observational studies reporting on dermatological presentations in emergency departments were included. Data extraction and quality assessment were performed using the Newcastle–Ottawa Scale, and results were synthesized narratively. Results:  Ten studies from the United States, Turkey, Saudi Arabia, and Germany were included, with sample sizes ranging from 204 to over 11,000 patients. Infections, urticaria, eczema, and drug eruptions were the most common presentations. Stevens–Johnson syndrome, toxic epidermal necrolysis, and severe drug reactions accounted for most admissions. Over 90% of patients were discharged without hospitalization. Admission rates ranged from 6% to 18%. Seasonal variation was observed in Saudi Arabia, while the COVID-19 pandemic shifted consultation patterns in Turkey. Teledermatology show effectiveness in diagnostic support, particularly in resource-limited settings. Conclusion: Most dermatological emergency department visits are non-urgent and can be managed on an outpatient basis. Early recognition of severity markers is essential to prevent adverse outcomes. Integration of standardized triage systems, physician training, and teledermatology can improve diagnostic accuracy, reduce inappropriate ED utilization, and optimize patient management.