BI17 Cutaneous disease in immunosuppressed haematology and oncology patients: implications for dermatology services

Abstract

St James’s Hospital has the largest haematology and oncology departments in Ireland. Its stem cell transplant unit is the third largest in the UK and Ireland, having performed over 2500 stem cell and bone marrow transplants. Advances in immunotherapy and targeted treatments have increased dermatological adverse effects, including severe cutaneous reactions, driving growing demand for specialized dermatology input for complex, immunosuppressed inpatients. We conducted a departmental audit to evaluate the frequency, complexity and outcomes of dermatology consultations originating from haematology and oncology services over a 4-month period. During this time, haematology and oncology referrals accounted for 17% of all inpatient dermatology consults (9% haematology and 8% oncology). A substantial proportion of these consultations required intensive dermatological input: 42% necessitated skin biopsy, and 43.7% of biopsied cases were subsequently discussed at our multidisciplinary dermato­pathology meeting. Each consultation required a median of three registrar reviews, and approximately one-half of patients required formal outpatient dermatology follow-up. Drug reactions represented the most common diagnosis, accounting for 51.3% of cases. Of these, 35% were attributed to immunotherapy, chemotherapy or targeted therapy, including ipilimumab, nivolumab, pembrolizumab, paclitaxel–carboplatin, folinic acid–fluorouracil–­oxaliplatin (FOLFOX) and enfortumab vedotin. Antibiotics represented the next most frequent cause of drug reactions (13.5%), most commonly vancomycin, linezolid, meropenem and piperacillin–­tazobactam. Inflammatory dermatoses accounted for 37.8% of diagnoses and included folliculitis, rosacea, psoriasis, erythema nodosum, Sweet syndrome, dermatomyositis and lupus. Notably, 10.8% of patients were diagnosed with cutaneous haematological malignancies. This audit highlights the significant and growing workload generated by haematology and oncology referrals to dermatology services, characterized by diagnostic complexity, frequent need for biopsy, and close follow-up. These findings support consideration of dedicated dermatology resources, such as a funded registrar role, to manage the increasing burden of dermatological disease in immunosuppressed patients.