Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Dermatology Emergencies

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Dermatological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)	Prodrome of fever, malaise, and sore throat followed by painful, rapidly spreading red or purpuric macules. Blistering and extensive skin detachment, often starting on the face and trunk. Mucous membrane involvement with painful erosions in the mouth, eyes, and genitals.	Clinical diagnosis based on skin findings and patient history (often related to recent drug exposure). Skin biopsy shows full-thickness epidermal necrosis. Laboratory tests to monitor organ function and electrolyte levels.	Immediate discontinuation of the offending drug. Supportive care in a burn unit or ICU, including fluid and electrolyte management. Systemic corticosteroids or IV immunoglobulin (IVIG) may be considered in severe cases. Ophthalmologic consultation for eye involvement and long-term monitoring for sequelae.
Necrotizing Fasciitis	Rapidly spreading erythema, severe pain, and swelling often out of proportion to physical findings. Fever, crepitus, and skin necrosis with bullae formation. Progresses to systemic toxicity, including hypotension and multiorgan failure.	Clinical diagnosis, often confirmed with surgical exploration showing necrotic fascia. CT or MRI may show gas in the soft tissues. Blood cultures, wound cultures, and laboratory tests including CBC, CRP, and creatine kinase (CK).	Immediate broad-spectrum IV antibiotics (e.g., piperacillin-tazobactam, clindamycin, vancomycin). Urgent surgical debridement of necrotic tissue. Intensive care support for septic shock and multiorgan failure. Hyperbaric oxygen therapy may be considered as an adjunctive treatment.
Staphylococcal Scalded Skin Syndrome (SSSS)	Fever, irritability, and generalized erythema with tenderness. Large, flaccid bullae that easily rupture, leaving behind denuded skin. Commonly affects infants and young children.	Clinical diagnosis based on characteristic skin findings. Positive Nikolsky sign (skin sloughing with gentle pressure). Blood cultures may identify Staphylococcus aureus; skin biopsy shows a split in the epidermis at the granular layer.	Immediate IV antibiotics effective against Staphylococcus aureus (e.g., oxacillin, nafcillin, or vancomycin). Supportive care with fluid and electrolyte management, similar to burn care. Wound care to prevent secondary infections.
Angioedema	Sudden onset of deep swelling in the skin, mucous membranes, and subcutaneous tissues, often affecting the face, lips, and airway. May be associated with urticaria and can lead to airway obstruction. Common triggers include medications (e.g., ACE inhibitors), foods, insect stings, and hereditary angioedema.	Clinical diagnosis based on history and physical examination. Measurement of C1 esterase inhibitor levels if hereditary angioedema is suspected. Monitoring of airway status and oxygen saturation.	Airway management is the first priority; intubation may be necessary. Administration of epinephrine, antihistamines, and corticosteroids for allergic angioedema. For hereditary angioedema, C1 esterase inhibitor concentrate or fresh frozen plasma may be administered. Observation and supportive care in a monitored setting.
Disseminated Intravascular Coagulation (DIC) with Purpura Fulminans	Sudden onset of widespread purpura, petechiae, and ecchymoses, often with necrosis and gangrene. Associated with severe sepsis, trauma, malignancy, or obstetric complications. Signs of systemic bleeding, thrombosis, and organ failure.	Clinical diagnosis supported by laboratory findings of DIC (prolonged PT, aPTT, low platelets, elevated D-dimer). Blood cultures and other investigations to identify the underlying cause. Skin biopsy may show thrombotic occlusion of small vessels.	Treat the underlying cause (e.g., antibiotics for sepsis, delivery for obstetric causes). Supportive care with IV fluids, blood products, and management of organ dysfunction. Heparin or antithrombin III may be considered in some cases of DIC.
Erythroderma	Widespread erythema and scaling affecting more than 90% of the body surface area. May be associated with pruritus, fever, and malaise. Common causes include psoriasis, atopic dermatitis, drug reactions, and cutaneous T-cell lymphoma.	Clinical diagnosis based on extensive skin involvement. Skin biopsy may help determine the underlying cause. Blood tests to assess for infection, organ dysfunction, and electrolyte imbalances.	Identify and treat the underlying cause (e.g., discontinue offending drug, treat infection). Supportive care with fluid and electrolyte management, temperature regulation, and nutritional support. Topical corticosteroids and emollients for skin symptoms. Hospitalization is often required for severe cases.
Acute Generalized Exanthematous Pustulosis (AGEP)	Sudden eruption of numerous small, non-follicular pustules on a background of erythema. Often associated with fever, leukocytosis, and malaise. Commonly triggered by drugs (e.g., beta-lactam antibiotics, calcium channel blockers).	Clinical diagnosis based on characteristic skin findings and recent drug exposure. Skin biopsy shows subcorneal pustules and spongiform pustules in the epidermis. Blood tests may show leukocytosis and elevated inflammatory markers.	Immediate discontinuation of the offending drug. Supportive care, including antipyretics and fluid management. Topical or systemic corticosteroids may be used in severe cases. Most cases resolve within 1-2 weeks after stopping the causative drug.
Herpes Simplex Virus (HSV) Encephalitis	Fever, headache, confusion, seizures, and focal neurological deficits. May be associated with vesicular lesions on the skin or mucous membranes. Rapid progression to coma and death if untreated.	CSF analysis showing elevated protein, lymphocytic pleocytosis, and normal glucose levels. PCR testing of CSF for HSV DNA is the gold standard for diagnosis. MRI of the brain may show temporal lobe involvement.	Immediate initiation of IV acyclovir. Supportive care, including seizure management and monitoring for increased intracranial pressure. Close monitoring in an ICU setting due to the potential for rapid deterioration.

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