We enjoyed reading the editorial regarding the future of medical dermatology by Lynch.1 We agree that the continued expansion of dermatology into surgical and cosmetic venues has strengthened our field without a negative impact on medical dermatology, but we disagree on how best to manage hospitalized patients with dermatologic problems.
In contrast to Lynch, we believe that it is in the best interest of our sickest patients whose illnesses are due to skin disease to be cared for by dermatologists. Over the years, dermatologists have treated the sickest of our patients and have done so in an effective manner and, in many countries, continue to do so.2 In the United States the shift to nondermatologists caring for hospitalized patients with severe skin disease is not a result of the superiority of care these physicians provide, but due to factors such as the implementation of the diagnosis-related groups. This shift has resulted in the closing of dermatology beds in many centers, since most hospital-based physicians have found it easier not to care for sick patients than to make adjustments to enable themselves to practice within the diagnosis-related group system.
Kerdel FA, Kirsner RS. Who Should Care for Hospitalized Patients With Severe Skin Disease?. Arch Dermatol. 1998;134(9):1159. doi: