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V. vulnificus is an uncommon cause of soft tissue infection and primary septicemia, especially in patients with hepatic disease or who patients who are immunocompromised. The mortality of infection in these patients is extremely high despite timely antibiotic therapy. It is important to consider the possibility of infection with V. vulnificus in patients who present with high fever and rapidly progressive sepsis and have a history of consumption of raw seafood (especially oysters) or exposure of open wounds in a marine environment. Public education regarding the risk of raw seafood consumption is essential to preventing infection with this virulent pathogen.

Currently, only a minority of dermatologists participate in the primary hospital care of patients with severe skin disease. However, an opportunity exists to alter this course. We believe the current course is a detriment to our specialty, and as a specialists we should provide the care for the full spectrum of dermatologic diseases. Moreover, by not delivering complete dermatology care, our specialty also stands to lose respect from both our patients and peers. Our experience at UM suggests that the creation of a cadre of dermatology hospitalists at selected academic medical centers would allow improved patient hospital care, education, and research.

The University of Miami Department of Dermatology has maintained an active inpatient unit. Analysis of data from a 12 month period from 1995-1996 showed 562 admissions. Cutaneous lymphoma, psoriasis, and chronic wounds accounted for over half the admissions. Most patients were insured by a fee-for-service system, and compared to patients insured by managed care systems or patients who were indigent, fee-for-service patients had the shortest length of stay. Using a case mix severity index, indigent patients had the greatest disease severity followed by fee-for-service patients. Patients enrolled in managed care systems had the least severity suggesting that factors other than disease severity alone may play a role in determining why patients are admitted.

Changes in the health care delivery system have profoundly affected medical dermatology in the United States. Although a significant number of patients are still being admitted for skin and skin-related disorders, only a minority are now admitted by dermatologists. An analysis of the mechanics of such a change and a national perspective is presented.

The use of immunosuppressive agents in dermatology has increased widely. The role of these medications has become increasingly important for the treatment of dermatologic disorders in an inpatient setting, where there is frequently a requirement for highly potent, fast-acting, effective agents. This article presents an overview of the general application, mechanisms of action, metabolism, and adverse effects commonly associated with systemic immunosuppressive agents used in dermatology.

Antimalarial compounds have been demonstrated to be both safe and efficacious in the treatment of lupus erythematosus as well as several other dermatologic conditions. It is imperative, however, that physicians familiarize themselves with the potential complications associated with the use of these agents. Furthermore, it is essential that a successful collaborative relationship be developed between the dermatologist and the ophthalmologist who are to treat and monitor the patient to avoid any untoward complications that might afflict the patient. It is important to stress that patients on antimalarial drug therapy be evaluated by an ophthalmologist prior to starting treatment and every 4 to 6 months thereafter. The use of Amsler's grids in compliant patients is recommended. If the patient develops retinal changes consistent with the diagnosis of premaculopathy, then careful consideration should be given to the availability and use of alternative agents.

Parasitic diseases, once limited to developing countries, may be seen in the United States with increasing frequency as air travel links continents. When cutaneous manifestations of these diseases are a part of the clinical picture, dermatologists are often called upon to contribute to the diagnosis. Amebiasis may result in painful anogenital ulcers; African trypanosomiasis (sleeping sickness) often begins with the trypanosomal chancre at the site of parasitic entry, and American trypanosomiasis (Chagas' disease) most commonly presents as Romaña's sign. Epidemiology, pathophysiology, immunology, clinical presentation, and treatment are reviewed for each of these diseases.