Beyond Biopsy: Bedside Recognition and Empiric Management of Life-Threatening Cutaneous Findings in Hospitalized Patients

Authors

• Timothy Smith, Rochester Regional HealthFollow

Document Type

Presentation

Department

Dermatology

Abstract

Beyond Biopsy: Bedside Recognition and Empiric Management of Life-Threatening Cutaneous Findings in Hospitalized Patients. Timothy Smith, PA-C; RRH Dermatology

Objectives:

• Apply a morphology-based framework to rapidly categorize and triage inpatient skin findings at the bedside 
• Distinguish retiform (branching) from nonbranching purpura and initiate the appropriate urgent workup and cause-specific treatment for microvascular occlusion syndromes such as purpura fulminans and calciphylaxis 
• Differentiate DRESS from a benign morbilliform drug eruption using clinical and laboratory criteria alone and initiate timely corticosteroid therapy 
• Recognize the clinical features of SJS/TEN and necrotizing fasciitis--including the Nikolsky sign and pain out of proportion--and initiate immediate lifesaving interventions without waiting for pathologic confirmation 
• Recognize pyoderma gangrenosum as a frequently misdiagnosed neutrophilic dermatosis--characterized by rapidly progressive painful ulcers with violaceous undermined borders and pathergy and initiate empiric immunosuppressive therapy while avoiding debridement, which can worsen the disease

Publication Date

8-5-2026

Recommended Citation

Smith, T. (2026). Beyond Biopsy: Bedside Recognition and Empiric Management of Life-Threatening Cutaneous Findings in Hospitalized Patients. Retrieved from https://scholar.rochesterregional.org/grandrounds_rgh/180