Analysis of the Cutaneous Manifestations of Patients in the Intensive Care Unit

Lee, Mi Jung; Shin, Cheung Soo; Lew, Wook

Abstract

BACKGROUND
Although primary dermatological conditions requiring intensive care unit (ICU) admission is rare, skin lesions due to manifestations of systemic diseases or complications in the critically ill patients are relatively common. During the process of critical care for the significant illness, the skin lesions are often ignored in daily clinical examination. OBJECTIVE: We have analyzed the skin manifestations of patients in the ICU and to correlate them with ventilator care, nutrition and the period of admission. METHODS: Among 113 patients in the ICU, 83 with ventilator care and 30 without ventilator care were examined for their skin lesions. The dermatologic conditions were classified into 5 groups: (1) primary skin diseases requiring intensive care; (2) dermatologic disorders due to multi-system disorders; (3) skin diseases as complications of intensive care; (4) previously acquired coincidental dermatologic diseases; and (5) nonspecific cutaneous manifestations. Dermatologic conditions in each category between the ventilator group and the non-ventilator group were compared. RESULTS: The study results are summarized as follows: 1. The incidence of cutaneous manifestations was 80.5% (91/113) in total, 80.7% (67/83) in the ventilator group and 80.0% (24/30) in the non-ventilator group. 2. The skin manifestations of ICU patients were classified into primary dermatological conditions, multi-system disorders with cutaneous signs, skin conditions developing as the complications of intensive care, previous dermatologic disorders, and nonspecific cutaneous symptoms which were 0 cases (0%), 25 cases (22.1%), 32 cases (28.3%), 37 cases (32.7%) and 45 cases (39.8%) respectively. Twenty-two patients had no skin lesions. These manifestations were not significantly different between the ventilator group and the non-ventilator group. 3. The incidence of xerosis was elevated in proportion to the period of admission. 4. Nonspecific cutaneous manifestations such as edema on the extremities and xerotic skin were not correlated with the nutritional status of the patients. CONCLUSION: The most common dermatologic manifestation in ICU patients is nonspecific skin lesion such as peripheral edema and xerotic skin. The incidence of xerosis was related with the periods of admission, it is considered that the longer the duration of hospitalization was, the dryness of the ICU environment and the exposed skin of patients were increased. Therefore the dryness should be corrected and the exposure of the skin should be avoided.