« Back to Emergencies and Miscellaneous Problems

Dermatologic Emergencies

»	“Dermatologic emergencies” sounds like an oxymoron. Are there dermatologic emergencies?
»	What are the major groups of dermatologic emergencies?
Vesiculobullous Disorders and Drug Reactions
»	How does toxic epidermal necrolysis differ from the Stevens-Johnson syndrome or erythema multiforme major?
»	How do you treat TEN?
»	How do you treat Stevens-Johnson syndrome?
»	What is pemphigus vulgaris?
»	Describe Nikolsky’s sign and its relationship to pemphigus vulgaris.
»	How is pemphigus vulgaris treated?
»	What is the DRESS syndrome?
Infectious Diseases
»	Are any dermatologic emergencies infectious in origin?
»	Can emergent infections be differentiated by their cutaneous presentations?
»	What is the differential to consider in hemorrhagic lesions other than infection?
»	What causes necrotizing fasciitis?
»	Describe the clinical presentation of necrotizing fasciitis.
»	Can other cutaneous infections look like necrotizing fasciitis?
»	Are there any parasitic disease “emergencies” that have cutaneous manifestations?
»	Are there any other parasitic disease emergencies?
»	Do mycobacterial infections cause any dermatologic emergencies?
Autoimmune Disorders
»	What collagen vascular diseases may become dermatologic emergencies?
»	What are the cutaneous findings in acute and bullous SLE?
»	How does neonatal lupus erythematosus (NLE) present?
»	Why are prompt recognition and treatment of NLE important?
»	Why is dermatomyositis considered an emergency?
»	What is leukocytoclastic vasculitis?
»	What are the skin signs of Still’s disease?
Inflammatory Cutaneous Disorders
»	Why is pyoderma gangrenosum a dermatologic emergency?
»	How does pyoderma gangrenosum present?
»	Under what circumstances do childhood vascular anomalies become dermatologic emergencies?
»	How are hemangiomas treated?
»	Is acne fulminans a dermatologic emergency?
»	What is the treatment for acne fulminans?
»	Are there drug eruptions that are dermatologic emergencies?
»	What are the mucocutaneous findings in Kawasaki’s disease?
»	How do you treat Kawasaki’s syndrome?
Environmental Disorders
»	Is heatstroke considered a dermatologic emergency?
»	What are the cutaneous signs of child abuse?
»	What are the skin signs of a lightning strike?
»	What is scleredema neonatorum?
»	What are the cutaneous findings in cholesterol emboli?
»	How are cholesterol emboli diagnosed?

Can emergent infections be differentiated by their cutaneous presentations?

Fig. 64.3 Palpable purpura and ecchymoses in a patient with meningococcemia. (Courtesy of the William L. Weston, M.D. Collection.)

Yes, although few cutaneous findings in emergent infections are pathognomonic. Infections that involve the skin can be organized generally by the appearance of the primary lesion (Table 64-2). Major cutaneous patterns of presentation include

Petechial/purpuric papules (e.g., chronic gonococcal septicemia, meningococcemia, subacute/acute bacterial endocarditis, and Rocky Mountain spotted fever) (Fig. 64-3)
Vesicular (e.g., neonatal herpes simplex, Kaposi’s varicelliform eruption)
Pustular (e.g., disseminated candidiasis)
Maculopapular (e.g., hepatitis B, Lyme disease)
Diffusely erythematous (e.g., staphylococcal scalded skin syndrome)

Table 64-2. Diagnostic Signs in Dermatologic Infectious Emergencies
	Petechial/Palpable Purpura Neisseria gonorrhoeae septicemia Neisseria meningitidis septicemia Acute/subacute bacterial endocarditis (Staphylococcus aureus, streptococci) Rickettsia rickettsii (Rocky Mountain spotted fever) Rickettsia prowazekii (louse-borne typhus) Borrelia sp. (relapsing fever) Hemorrhagic fevers (dengue, Rift Valley, Congo-Crimean, Korean) Cytomegalovirus (viral hepatitis) Hepatitis B virus Yellow fever Rubella Plasmodium falciparum (malaria) Trichinosiss
	Violaceous Skin Discoloration Infectious gangrene Necrotizing fasciitis Mucormycosis
	Purpura Fulminans (Purpura Secondary to Disseminated Intravascular Coagulation) Neisseria meningitidis Streptococcus spp. Escherichia coli Salmonella typhi Bacteroides fragilis Other enteric gram-negative organisms Hemorrhagic fevers Vibrio vulnificus
	Vesicular Neonatal herpes simplex virus Disseminated vaccinia
	Pustular Staphylococcal endocarditis/sepsis Disseminated candidiasis Herpes simplex virus Corynebacterium diphtheriae
	Diffuse Erythema Toxic shock syndrome
	Maculopapular Eruptions Viral infections Rickettsial infections Spirillum minor (rat-bite fever) Disseminated fungal infections Toxoplasma gondii Tularemia Leptospirosis
	Annular Erythema Lyme disease (Borrelia burgdorferi)