Abstract

Acute skin conditions are common in childhood and frequently present to emergency departments and family medicine clinics. Data on diagnostic performance and early management in these settings are limited. A systematic review was conducted according to PRISMA 2020 guidance. Electronic databases were searched from inception for observational studies and case series reporting acute pediatric dermatologic presentations in emergency or primary care settings. Two reviewers screened studies, extracted data, and performed narrative synthesis. A total of 9 studies were included from Europe, the Middle East, and Asia. In emergency departments, dermatologic conditions accounted for 4 to 6% of pediatric visits when primary skin complaints were counted and 17% when any skin finding was recorded. Infections and allergic dermatoses were the most common diagnoses, while drug eruptions and vasculitic rashes represented smaller groups. Hospital admission of children with skin disease ranged from 5% to 11%, mainly for severe infections, vasculitides, and drug reactions. Diagnostic uncertainty was common, and 10-24% of cases were coded as suspected or unknown. Studies comparing pediatrician diagnoses with dermatologists found a diagnostic agreement of 55 to 66%, with changes in diagnosis and treatment. Acute pediatric dermatologic presentations are common in ED and often managed with limited diagnostic certainty. To improve diagnostic precision, basic dermatology training, use of simple visual algorithms, and integration of teledermatology consultation into ED services is required.

Key words: Pediatric dermatology, skin diseases, emergency department, family medicine, diagnostic accuracy, systematic review.