Cutaneous manifestations in patients attending the hematology clinic at King Fahd Hospital of the University during a 13 week-period

Iqbal A. Bukhari1, Osama Al Sultan2, Abdulaziz Al Zahrani1, Huda Alsuwaylih1, Doaa Al Najim1, Alla Altammar1

1Department of Dermatology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Dammam, Saudi Arabia, 2Department of Internal Medicine, College of Medicine, University of Dammam and King Fahd Hospital of the University, Dammam, Saudi Arabia

Corresponding author: Prof. Iqbal A. Bukhari, E-mail: ibukhari@uod.edu.sa
Submission: 08.11.2014; Acceptance: 25.01.2015
DOI: 10.7241/ourd.20152.41


Background: Cutaneous disorders are common in patients with hematological diseases especially anemia. Dermatologists usually contribute to the management of these patients in parallel with other medical specialties.

Aim: To report common dermatological problems in patients attending the hematology clinic at a secondary care hospital.

Materials and Methods: The study was conducted at the hematology clinic of King Fahd Hospital of the University during a thirteen week period starting 17th of November, 2013 till 31st of January, 2014. All patients were fully examined and a consultative opinion was given to the attending hematologist. Data sheet was filled and analyzed by SPSS (Statistical Package for the Social Sciences) software version 17.0.

Results: 138 patients were seen during the period of 13 weeks. There were 27 males and 111 females. Hemoglobin level was less than 10 gm/dl in 40.6% of patients. The most common reported cutaneous features were diffuse alopecia, hair thinning, pallor, pruritus, fragile skin, easy brusability, dry mouth and gum bleeding in descending frequency.

Conclusion: Hematology patients suffered from variable dermatological disorders which suggest the importance of the initial dermatology consultation for those patients as part of their management plan.

Key words: Anemia; Alopecia; Dermatitis; Pallor; Pruritus


Dermatologists play an important role in providing consultative service to other medical specialties. Previous studies have shown that the discipline of Medicine make the most requests for inpatient dermatologic services [14]. While most requests for dermatologic consultations are for common skin conditions, challenging scenarios and diagnostic dilemmas are frequently encountered. Skin problems are common in patients with hematological disorders and dermatologist usually add to the management plan of those patients.


To characterize the profile of dermatological issues frequently encountered in patients attending the hematology outpatient clinic at King Fahd Hospital of the University during three months period.


This prospective cross sectional study was conducted at the hematology outpatient clinic of King Fahd of the University Hospital in Alkhobar, Saudi Arabia during a 13-week period starting 17th of November, 2013 till 31st of January, 2014. The Hematology Department in this hospital accepts referrals from other departments and outside hospitals in the Eastern Province also. All patients were fully examined by a consultant dermatologist with assisting interns trained by the dermatologist. Data sheet was filled for each patient with documentation of age, gender, associated conditions and all observed cutaneous lesions. Data was entered in the computer and analyzed by SPSS (Statistical Package for the Social Sciences) software Version 17.0.


A total of 138 patients were examined during the study period. There were more females (n = 111; 80.4%) than males (n = 27; 19.6%) and the mean age was 45 years (range: 13-66 years). Hemoglobin level was less than 10 gm/dl in 40.6% of patients and less than 9 gm/dl in 21.7%. Causes of anemia in a descending frequency included Iron deficiency anemia 73 (53%), sickle cell anemia 37 (26.8%), thalassemia 15 (10.9%) and less than 10 cases with G6PD (Glucose-6-phosphate dehydrogenase), thrombocytopenia, vitamin B12 defeciency and leukemia. A total of 67 dermatologic conditions were diagnosed Table 1. The frequency of these dermatologic conditions in descending pattern included: alopecia 92 (66.7%), pallor 71 (51.4%), thinning of the hair 54 (20.3%), skin dryness 49 (35.5%), pruritis 33 (23.9%), increased skin fragility 28 (20.3%), dry mouth 21 (15.2%), gum bleeding 18 (13%), dermatitis 17 (12.3%), jaundice 17 (12.3%) and fragile ridged nails. Different types of dermatitis were represented, ranging from contact, asteatotic, seborrhoeic and nummular eczema Figure 1. None of the patients had a skin biopsy because a clinical diagnosis was deemed sufficient. There was other associated medical conditions in some patients including hypertension, diabetes mellitus, hepatitis c, liver cirrhosis, gastritis, dyslipidemia, hypothyroidism, congenital adrenal hyperplasia, acne vulgaris, discoid lupus eruthematosus and psoriasis.

Table 1: Percentage of some of the reported cutaneous conditions found our patients
Figure 1: Variable skin, nail and hair changes in our patients. A. Dermatitis and severe dryness. B. Brittle nail with super imposed fungal infection. C. Nail Clubbing. D. Diffuse alopecia


Cutaneous problems are common in patients with anemia. Unfortunately no similar study was previously conducted in Saudi Arabia to compare it. However, the study reveals the importance of internist, hematologist and dermatologist in the management of patients with anemia. In a random review of patients admitted to a Hematology-Oncology unit, Pearson et al found mucocutaneous disorders in 88% of cases seen. The most common findings in their study were alopecia, mucositis, palm and sole erythema [5]. In another similar study done by Hy Koh in Singapore [6], 692 patients were referred for primary dermatological issues during six months period. This is implies that non-dermatologists face difficulties diagnosing common dermatoses [1,4,710]. Besides, a dermatologic consultation resulted in changes in diagnosis and management in 60% to 77% of the cases [1,8,10], which highlights the importance of dermatologic education of the consulting physicians regardless of his specialty [11]. Our findings in this study highlights the importance of the involvement of the dermatologist in the management of hematology patients through initial consultation as part of their general management plan.


The examination of the patient was conducted according to the Declaration of Helsinki principles. Ethical Requirements for Studies Involving live human subjects or animal: accepted by all authors.

Written informed consent was obtained from the patient for publication of this article.


1. Falanga V, Schachner LA, Rae V, Ceballos PI, Gonzalez A, Liang G, Dermatologic consultations in the hospital settingArch Dermatol 1994; 130: 1022-5.

2. Bauer J, Maroon M, Dermatology inpatient consultations: a retrospective studyJ Am Acad Dermatol 2010; 62: 518-9.

3. Mancusi S, Festa Neto C, Inpatient dermatological consultations in a university hospitalClinics (Sao Paulo) 2010; 65: 851-5.

4. Penate Y, Guillermo N, Melwani P, Martel R, Borrego L, Dermatologists in hospital wards: an 8-year study of dermatology consultationsDermatology 2009; 219: 225-31.

5. Pearson IC, Sirohi B, Powles R, Treleaven J, Mortimer PS, The impact on resources of prevalence and nature of skin problems in a modern intensive haemato-oncology practiceHematology 2004; 9: 415-23.

6. Koh H, A retrospective analysis of dermatological problems in a hematology wardClin Cosmet Investig Dermatol 2013; 6: 145-9.

7. Maza A, Berbis J, Gaudy-Marqueste C, Morand JJ, Berbis P, Grob JJ, [Evaluation of dermatology consultations in a prospective multicenter study involving a French teaching hospital]Ann Dermatol Venereol 2009; 136: 241-8.

8. Tay LK, Lee HY, Thirumoorthy T, Pang SM, Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatologyClin Exp Dermatol 2011; 36: 129-34.

9. Itin PH, Dermatologic consultations in the hospital ward: the skin, an interdisciplinary organDermatology 2009; 219: 193-4.

10. Davila M, Christenson LJ, Sontheimer RD, Epidemiology and outcomes of dermatology in-patient consultations in a Midwestern US university hospitalDermatol Online J 2010; 16: 12.

11. Fox LP, Cotliar J, Hughey L, Kroshinsky D, Shinkai K, Hospitalist dermatologyJ Am Acad Dermatol 2009; 61: 153-4.


Source of Support: Nil

Conflict of Interest: None declared.



Other Resources

Our Dermatology Online

Current Issue
All Issues
Instruction for authors
Submit Manuscripts
Ethics in Publishing
For Reviewers
Editors & Publishers 
Contact Us