Review ar cle Dermatological emergency and life threatening skin condi ons.
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Review ar�cle
Dermatological emergency and life threatening skin condi�ons.
Mohammed Saiful Islam Bhuiyan1
1. Associate Professor, Department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Abstract
Dermatology is known to be a non-emergency cool discipline, but many dermatological en��es really
deserve special immediate interven�on. Some of them also have significant disease related fatality.
Understanding the e�opathogenesis and disease course of these condi�ons are very important to save
pa�ent’s life. Among them severe drug reac�ons, acute ur�caria, angioedema, anaphylaxis,
erythroderma, flare of pre-exis�ng inflammatory dermatoses, bullous diseases and infec�ons including
staphylococcal scalded skin syndrome (SSSS), necro�zing fascii�s (NF) etc. Failure of �mely diagnose and
intervene against many of these condi�ons may lead to acute skin failure and mul�organ failure. This
ar�cle is aimed to discuss dermatological emergencies, their e�opathogenesis, consequences, diagnosis
and management.
Keywords: Dermatology, Emergency, Dermatological emergency, Acute skin failure.
nature and extend of emergency dermatological
Introduc�on: situa�on which will ensure �mely and appropriate
Dermatological diseases are the fourth leading iden�fica�on of dangerous skin condi�on to take life
cause of nonfatal burden in global disease burden saving measures.
(GBD).1 Cutaneous and subcutaneous diseases were Certain situa�ons are really candidates for emergen-
responsible for 41.6 million Disability-Adjusted Life cy interven�on; Acute ur�caria, angioedema,
years (DALY) and 39.0 million Years loss due to erythrodermic flares of preexis�ng dermatoses like
disability (YLD) in 2013.2 Dermatological diseases psoriasis, atopic derma��s etc, boils, celluli�s,
imposes physical disability, discomfort, disfigura- staphylococcal scalded skin syndrome, sep�cemia,
�on, psychological distress and even death. As skin toxic shock syndrome, necro�zing fascii�s, erythe-
lesions are readily visible and present mostly with ma mul�forme, drug reac�on with eosinophilia and
pruritus, it creates significant impact on daily quality systemic symptoms (DRESS), Stevens-Johnson
of life.3-4 Though dermatology is generally consid- syndrome, toxic epidermal necrolysis (TEN), acute
ered as a cool and non-emergency discipline but generalized exanthematous pustulosis (AGEP),
very o�en some situa�ons demand emergency care. anaphylac�c drug reac�on, vasculi�s, etc. ,
All over the world a good propor�on of pa�ents Dermatological emergencies: Although there is no
come to emergency room for their skin problems. well-established defini�on of the word dermatologi-
Some�mes skin is primarily involved and in other cal emergency, any disease presen�ng with general-
situa�ons skin manifests some signs of dreadful ized cutaneous and mucous membrane involvement
internal diseases. In emergency department 3-21% which demands urgent life-saving interven�ons.
of a�ending pa�ents seek care for dermatological Dermatological emergency can be defined as ‘an
issues and among pediatric popula�on it may be up acute or worsening derma��s forReview ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
Table I: Dermatological diseases need emergency care.9-12
Dermatological emergencies
Group of diseases Cause
Infec�ous skin diseases Staphylococcal toxic shock syndrome, staphylococcal scalded
skin syndrome, streptococcal toxic shock syndrome, necro�z-
ing fascii�s, celluli�s, sep�cemia, cutaneous abscess/furun-
cle/carbuncle, meningococcemia, Lyme disease, viral exan-
thema, measles, chicken pox, herpes zoster, Rocky Mountain
spo�ed fever, acute paronychia, disseminated candidiasis
Ur�caria, angioedema and Viral infec�on, medica�ons, foods, radiocontrast media, hair
anaphylaxis dye, arthropod and insect bite.
Drug reac�on Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis
(TEN) drug reac�on with eosinophilia and systemic symp-
toms (DRESS), drug reac�on with different hypersensi�ve
syndrome, acute generalized exanthematous pustulosis
(AGEP), ur�caria, and erythema mul�forme.
Inflammatory skin diseases Eczema, contact derma��s, pustular psoriasis, erythroder-
mic psoriasis.
Acute erythroderma Psoriasis, atopic derma��s, pityriasis rubra pilaris, seborrhe-
ic derma��s, pemphigus foliaceus, mycosis fungoides, sezare
syndrome.
Physical or agents Burn, irritant contact derma��s (acid, alkali, hair dye)
Auto immune bullous Pemphigus vulgaris, bullous pemphigoid
skin diseases
Connec�ve �ssue Acute SLE, Dermatomyosi�s, Leukocytoclas�c vasculi�s
disease, vasculi�s, (LCV), Henoch-Schonleinpurpura, poly arteri�s nodosum.
superficial thrombosis/
thrombophlebi�s
Benign or malignant tumor Mycosis fungoides, sezare syndrome, leukemia cu�s, mela-
noma, mastocytosis
Neonatal skin diseases Harlequin ichthyosis, epidermolysis bullosa, acroderma��s
enteropathica
Other condi�ons Acute gra�-versus-host disease (aGVHD), calciphylaxis,
purpura fulminans, Kawasaki disease, Sweet syndrome and
its his�ocytoid variant, pyoderma gangrenosum (PG), erythe-
ma nodosum, Lepra reac�on, diaper derma��s, Jarisch-Herx-
heimer etc.
Infec�ous skin diseases: leading (nearly half) cause of dermatology emergen-
Different bacterial, viral, fungal infec�on of skin, cy care in many studies.13-14 In an indian study by
subcutaneous or internal organ with wide array of Priyanka et al.leprosy, STDs and Herpes zoster (21%)
severity can present to dermatology outpa�ent were the leading cutaneous infec�ons those seek
department (OPD) or emergency room for urgent emergency care.15 Infec�ons which present with
care. This group of skin diseases were found as the redness, warmth, pain, tenderness, edema, fever,
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 18Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
blister, scalding etc. make pa�ents panic. Some of in managing drug reac�on.23
them are less serious ini�ally like acute paronychia Table II: Drugs commonly causes adverse drug
(pseudo dermatological emergency)and some are reac�on
real candidate of urgent lifesaving interven�on like
necro�zing fascii�s (NF), staphylococcal toxic shock Drugs
syndrome, staphylococcal scalded skin syndrome, An�-convulsants (Carbamazepine, Phenytoin,
streptococcal toxic shock syndrome, meningococce- Phenobarbital)
mia, sep�cemia, disseminated herpes simplex, NSAIDs (naproxen, ibuprofen, tramadol,
disseminated chicken pox, herpes zoster ophthalmi- indomethacin, ketoprofen, diclofenac)
cus or disseminated herpes zoster. Many maculo-
An�-microbial agents (Ciprofloxacin,
papular viral infec�ons especially mumps, measles,
Amoxicillin, Cotrimoxazol, tetracycline,
and rubella as well as other childhood viral infec�on
Doxicycline, Metronidazole and An�-TB drugs)
like roseola and erythema infec�osum warrant
pa�ent and parents a�end at emergency depart- Allopurinol
ment. Sulfasalazine
Ur�caria, angioedema and anaphylaxis:
Pa�ents with ur�caria with or without angioedema Dapsone
is very common in the popula�on and concerning to An�hypertensive
seek urgent supports for the painful, severe itchy
wheals to laryngeal edema, anaphylaxis and severe
respiratory problems. Ur�caria represents about Acute erythroderma:
11.4 to 68.1% of dermatological emergency.16-17 Acute erythroderma is another deadly skin condi-
Approximately 40% of pa�ents with ur�caria also �on develops due to generalized inflamma�on
experience angioedema (swelling that occurs affec�ng skin. It may develop in normal skin due to
beneath the skin).18 In USA each year 80,000 to underlying systemic inflamma�on or drug reac�on
112,000 pa�ents a�end emergency department (primary) or in pre-exis�ng skin diseases (systemic).
(ED) for angioedema and on average 4.0 persons for Very o�en it is misdiagnosed. Though the cause of a
each 100,000 persons need hospital admission.19 good number of erythroderma remain unse�led;
Vast majority of acute ur�caria, angioedema and erythrodermic flare of preexis�ng skin diseases
anaphylaxis are unknown and specific causes cannot including psoriasis, eczema, PRP, seborrheic derma-
be iden�fied. Viral infec�on as well as drug, food, ��s, pemphigus foliaceus, cutaneous lymphoma,
radio-contrast media, parasi�c infesta�on, insect or drug reac�on and internal malignancies are
arthropod bite are responsible for acute ur�caria, common in elderly.24 Erythroderma in children is
angioedema or anaphylaxis. Anaphylaxis is a uncommon but challenging situa�on for its life
drama�c situa�on that can rapidly progress to threatening poten�als. In infants and newborns
death. Hereditary angioedema is an uncommon.20 infec�ons, ichthyosiform erythroderma, atopic
Drug reac�on: SJS, TEN and DRESS syndrome: derma��s, infan�le seborrheic derma��s are
Adverse cutaneous drug reac�ons (ACDR) are very common cause.25In older children drug reac�on is
common en�ty that brings pa�ents to dermatologi- the commonest cause of erythroderma followed by
cal emergency. It is the commonest acute drug reac- psoriasis, genodermatoses, staphylococcal scalded
�on (ADR) and responsible for about 2% of hospital skin syndrome.25Understanding the cause and the
admissions.21-22 Pa�ents with history of taking differ- poten�al life threatening consequences is very
ent medica�ons may present with different varie�es important in the management erythroderma.
drug-induced severe cutaneous adverse reac�ons
(SCARs) include acute generalized exanthematous Bullous disease:
pustulosis (AGEP), drug reac�on with eosinophilia Bullous diseases are frightening condi�ons for
and systemic symptoms (DRESS), and epidermal pa�ents bring them to emergency department.
necrolysis (Stevens-Johnson syndrome [SJS], toxic Some of autoimmune bullous diseases including
epidermal necrolysis).23As each of these syndromes bullous pemphigoid (BP), pemphigus vulgaris, pem-
are dis�nct en��es with different clinical, biological, phigus foliaceus and paraneoplas�c pemphigus are
and histological pa�erns and iden�fy the par�cular really life threatening. These are mostly disease of
syndrome and the culprit medicine is the prime job elderly. Different types of hereditary epidermolysis
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 19Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
bullosa (EB) in children are very disabling and life Stevens-Johnson syndrome or angioedema with
threatening. dyspnea can be life-threatening. These situa�on can
lead to a dangerous sequelae “Acute skin failure”.
Mortality in dermatology: The term “skin failure” is not much known like
It is common believe that skin diseases are not that respiratory, cardiac or renal failure but in some
fatal but those work in dermatology wards very situa�ons skin fails to perform its func�on. Many
o�en face of pa�ents with different skin diseases. In dermatological condi�ons can disrupt the intercon-
an Indian study among admi�ed pa�ents for derma- nec�ng structural and func�onal integrity of skin.
tological problems yearly mortality rate was 3.58%. This inability to maintain structural and func�onal
A prospec�ve study on 309 pa�ents of erythroder- integrity of skin to conserve core temperature,
ma in Brazil over 12 years 9.1% died due to compli- water, electrolyte and protein leading to fluid-elec-
ca�on of erythroderma. 27 Though overall mortality trolyte imbalance and failure of its barrier func�on
due to angioedema is very low (0.36 deaths per to prevent entry of foreign substance.35
million popula�on) it creates significant physical Staphylococcal scalded skin syndrome (SSSS) is
discomfort and psychological impact.28TEN is one of ini�ated by the exfolia�ve (epidermoly�c) toxins
the most serious dermatological emergency (ET-ETA and ETB) of Staphylococcus aureus. Both
10%-70%pa�ents of TEN died principally due to toxins act specifically in the stratum granulosum of
severe complica�ons of mul�ple organ failure and the epidermis by a�aching to the filaggrin which
disseminated infec�ons.29 Pemphigus vulgaris and acts as intracellular anchors of desmosomes and
TEN are the leading skin disease of death and most ul�mately causes epidermal spli�ng.36
of the pa�ents are elderly (61-70 years) involving In the deadly flesh-ea�ng disease NF seeding of
large areas of skin, sepsis, pneumonia and bacteria occurs into the deep �ssue planes following
fluid-electrolyte imbalance.26 Mortality from pem- penetra�ve injury or surgery and bacteria rapidly
phigus was drama�cally reduced, from 75% to 30% mul�ply within viable �ssue. It may be either
a�er introduc�on of cor�costeroids in the early polymicrobial (mixture of aerobic and anaerobic
1950s and further use of adjuvant use of immuno- organisms, Gram-posi�ve organisms, such as Staph-
suppressants in the 1980s probably contributed to ylococcus aureus, S pyogenes, and enterococci;
the further decrease in mortality from the disease Gram-nega�ve aerobes, such as Escherichia coli and
itself to below 5%.30 Death rate for SSSS rate in Pseudomonas species; and anaerobic organisms,
children is 3% with �mely appropriate treatment, such as Bacteroides or Clostridium species) or
more than 50% in elderly and nearly 100% in those monomicrobial. Fibrous adherence between subcu-
with comorbidi�es, despite an�bio�c treatment.31 taneous �ssues and fasciae block extension of infec-
Mortality due to necro�zing fascii�s(NF) is alarming- �on in the hands, feet, and scalp and absence of
ly high, it is nearly 100% without surgical interven- such a�achments in the trunk, limbs, vessels favors
�on.32 Purpura fulminans is another grave condi�on spread of infec�on. Ul�mately it causes widespread
with mortality rate up to 35% but recent advance- �ssue destruc�on, edema, myosi�s, thrombosis,
ment in the diagnosis and treatment have improved ischemia and gangrene.32
the survival.33 In purpura fulminans rapidly progressing cutaneous
necrosis and disseminated intravascular coagula�on
Pathogenesis: occurs mostly in large vein vessels leading to wide-
Many serious skin diseases may impair structural spread mul�organ failure.33 Hereditary or acquired
and func�onal integrity of skin leads to different defect in protein C and /or protein S or other coagu-
complica�ons including infec�on, loss of fluid, la�on pathways, infec�on (Neisseria meningi�des,
electrolyte, protein and metabolic derangement. In Streptococcus pneumoniae, Group A and B strepto-
TEN/SJS full-thickness epidermis of the skin and cocci, Haemophilus influenzae, Staphylococcus
mucous membranes is sloughed. Involvement of aureus, other bacteria, Plasmodium falciparum) and
eyes, gastrointes�nal, genitourinary, and respiratory some unknown e�ology are behind this disseminat-
mucosa can cause grave situa�on like gastrointes�- ed intravascular coagula�on.33
nal bleeding, pulmonary embolism, myocardial In erythroderma where most of the water conserv-
infarc�on, pulmonary edema, and sepsis with ing capacity of epidermis is hampered and transpei-
mul�-organ failure.34 Like severe burn, diseases like dermal water loss raised up to forty �mes than the
SSSS, necro�zing fascii�s (NF), erythroderma, normal. Body also loses protein, sodium, chloride
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 20Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
and potassium which leads to reduce intravascular other cases of chronic erythroderma), and dilu�on
volume, forma�on of hyperosmolar urine, low due to hypervolemia (which is not of much signifi-
urinary output leads to renal failure. 37 Pa�ents with cance).38 Aspira�on pneumoni�s, pulmonary edema
toxic epidermal necrolysis and autoimmune bullous (secondary to capillary leak syndrome) and adult
disorders have, in addi�on, extra loss of Na+, K+ and respiratory distress syndrome (ARDS) are fatal
Cl- in the blister fluid. It also alters body metabolism respiratory complica�ons.39
enormously, cutaneous blood flow is raised and Evalua�on of dermatological skin condi�ons: An
causes huge heat loss. Increased compensatory emergency physician a�ending a pa�ent with
catabolic ac�vity and basal metabolic rate lead to dermatological complain or work at dermatology
hypoalbuminemia and severe edema. Increased ward should look for any feature sugges�ng life
cutaneous blood flow nearby doubles the cardiac threatening condi�on that need emergency
output and may contribute to high output cardiac support. Prompt response is essen�al in such
failure.37 dangerous situa�on with abnormal pulse, pressure,
Suppression of insulin secre�on and insulin resist- temperature, respira�on and level of consciousness.
ance cause hyperglycemia and glycosuria, which Suppose a pa�ent with wheals may present with
cause amino acid breakdown leading to further respiratory difficul�es due to laryngeal edema and
worsening of hypercatabolic state and condi�on of hypotension due to anaphylac�c shock or a toxic
the pa�ent. Both external and internal environment looking pa�ent presen�ng with petechiae, fever and
favors the growth of different organism leads to disorienta�on deserve immediate vital rescue. One
bacteremia, sepsis and death. 37 pa�ent having history of taking medica�on like
Pa�ents with acute generalized pustular psoriasis methotrexate and present with petechial rash
may develop acute hypocalcemia secondary to warrant different line of interven�on. So during
severe hypoalbuminemia. The principal nutrients evalua�ng an unknown skin condi�on search for
lost in acute skin failure are protein and iron. The some history, cutaneous and non-cutaneous signs
main causes of hypoproteinemia are con�nuous loss are important. Important history and physical
through shed scales, increased BMR, decreased findings that can give a key sign for diagnosis of a
hepa�c synthesis, dermatogenic enteropathy lead- skin disease needs emergency care (Table III and
ing to protein loss (seen in fulminant psoriasis and Table IV).
Table III: Important history and general examina�on features of dermatological emergency condi�ons.40
History and Diseases
general findings
Extreme age Neonates or infants: Meningococcemia, Kawasaki disease,
viral exanthema, Harlequin ichthyosis
Old age: Pemphigus vulgaris, meningococcemia, toxic epider-
mal necrolysis, Stevens-Johnson syndrome, hypersensi�vity
syndrome, toxic shock syndrome
Toxic look Necro�zing fascii�s, meningococcemia, toxic epidermal
necrolysis, Stevens-Johnson syndrome, hypersensi�vity
syndrome, toxic shock syndrome, Rocky Mountain spo�ed
fever
Altered mental status or Sepsis, hypo perfusion, and meningococcemia.
confusion
Severe itching Ur�caria, poison ivy, erythrodermic or pustular psoriasis,
acute exacerba�on of derma��s
Rapidity of progression Ur�caria, poison ivy, erythrodermic or pustular psoriasis,
acute exacerba�on of derma��s
Insect or bee infesta�on
Recrea�onal outdoor ac�vity travel history Dengue, malaria, hemorrhagic fever, Ebola,
or travel history lyme disease, Rocky Mountain spo�ed fever
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 21Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
Past medical history Pa�ent of valvular heart disease or intravenous drug users
may develop endocardi�s which may present with cutaneous
feature.
Drug Table II (Men�on in Table II)
Blood or blood product Anaphylaxis, transfusion related acute gra� versus host reac-
�on.
Chemical Hair dye and corrosive agents
ChemImmune statusical Disseminated herpes zoster, meningococcemia, necro�zing
fascii�s may develop in HIV cases, cancer chemo therapy,
diabe�c or other immune-compromised condi�ons.
Fever Chicken pox, measles and other viral exanthem, sepsis, Rocky
Mountain spo�ed fever, toxic shock syndrome, erythema
mul�forme, connec�ve �ssue disease, vasculi�s, Kawasaki
disease, Stevens-Johnson syndrome, toxic epidermal necrol-
ysis
Lymphadenopathy Sezare syndrome, drug reac�on with different hypersensi�ve
syndrome, leukemia cu�s
Low blood pressure Sep�cemia, toxic shock syndrome, meningococcemia, Rocky
Mountain spo�ed fever, toxic epidermal necrolysis,
Stevens-Johnson syndrome
Table IV: Skin presenta�ons of life threatening skin diseases:40
Cutaneous signs Diseases
Wheals Ur�caria, angioedema, anaphylaxis, Arthropod or insect
bite, mastocytosis, drug reac�on
Erythroderma Pemphigus foliaceus, erythrodermic psoriasis, Atopic
derma��s, pityriasis rubra pilaris, Sézary syndrome
Pustules Generalized pustular psoriasis, Acute generalized exanthe-
matous pustulosis (AGEP), subcorneal pustular dermatosis
of Sneddon and Wilkinson, Sweet syndrome, disseminated
candidiasis, Herpes simplex virus, and Staphylococcus
species.
Morbilliform erup�on Viral exanthems, drug reac�on with eosinophilia and
systemic symptoms (DRESS), Disseminated fungal infec�ons
Drug reac�ons Ricke�sia Toxoplasmosis
Petechiae Thrombocytopenia, leukemia, sepsis, meningococcemia,
endocardi�s, Malaria, Rocky Mountain spo�ed fever,
Tick-borne illnesses, methotrexate poisoning
Vesicles Pemphigus vulgaris, bullous pemphigoid, epidermolysis
bullosa, neonatal herpes simplex virus, smallpox, vaccinia
virus
Large denuded Pemphigus vulgaris
skin
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 22Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25
Oral or mucosal Erythema mul�forme major, toxic epidermal necrolysis,
or genital lesions Stevens-Johnson syndrome, pemphigus vulgaris
Hemorrhagic Meningococcemia
bullae
Violaceous, dusky Scleroderma, vasculi�s (SLE, ANCA-related vasculi�s, cryo-
discolora�ons, Ischemia of globulinemia, rheumatoid vasculi�s, etc.), embolic diseases,
the digits and limb, necro�zing fascii�s.
Necro�zing and gangrenous
area
Pain or Necro�zing fascii�s, celluli�s
tenderness of skin
Dermatologists should be cau�ous and careful in
Management: diagnosis, management, �mely interven�on and
This review is aimed to understand the burden of referral in these emergency situa�ons to prevent
emergency situa�ons in dermatology prac�ce. It is fatal consequences.
crucial to �mely diagnose the diseases which Conflicts of interest: No conflict of interest.
demands immediate appropriate interven�on and
seeking support from allied discipline or ICU. Con�n- References:
uous close monitoring of body temperature, heart 1. Hay RJ, Johns NE, Williams HC et al. The global
rate, pulse rate, urine (volume, osmolarity, glucose), burden of skin disease in 2010: an analysis of the preva-
and input-output chart should be ensured. Arterial lence and impact of skin condi�ons. Invest Dermatol.
blood gas analysis (ABG), complete blood count 2014 Jun; 134(6):1527-1534.
(CBC), blood urea, crea�nine, glucose, electrolytes, 2. Karimkhani C, Dellavalle RP, Coffeng LE et al. Global
albumin, LFT, complete urine examina�on and chest Skin Disease Morbidity and Mortality: An Update From
radiograph are essen�al. In pa�ents of severe the Global Burden of Disease Study 2013. JAMA Derma-
bullous drug reac�ons, pemphigus vulgaris, erythro- tol. 2017;153(5):406–412. doi:10.1001/jamaderma-
derma and acute skin failure loss of skin barrier tol.2016.5538
func�on, metabolic and other organ func�ons are 3. Nguyen SH, Nguyen LH, Vu GT et al. Health-Related
such grave that they need support like a pa�ent of Quality of Life Impairment among Pa�ents with Different
100% burn pa�ents. There are enough evidence Skin Diseases in Vietnam: A Cross-Sec�onal Study Int. J.
that management of TEN-SJS pa�ents in burn unit Environ. Res. Public Health 2019;16:305
significantly improve the pa�ent survival.41 4. Kini SP, DeLong LK, Veledar E et al. The impact of
pruritus on quality of life: the skin equivalent of pain.
Conclusion: Arch Dermatol 2011; 147(10): 1153–6.
Many pa�ents with dermatological condi�ons 5. Baibergenova A, Shear NH. Skin Condi�ons That
a�end in emergency department or OPD for emer- Bring Pa�ents to Emergency Departments. Arch Derma-
gency care. Some are really need immediate lifesav- tol. 2011;147(1):118–120
ing interven�on. Many admi�ed pa�ents in derma- 6. Gupta S, Sandhu K, Kumar B. Evalua�on of emergen-
tology wards also some�mes progress to cri�cal cy dermatological consulta�ons in a ter�ary care centre
stage which can be prevented by �mely assessment, in North India. J Eur Acad Dermatol Venereol.
management and appropriate referral. Certain 2003;17:303-5.
acute condi�ons need management in intensive 7. Shivaram V, Christoph RA, Hayden GF. Skin disor-
care unit. Though emergency situa�ons in dermatol- ders encountered in a pediatric emergency department.
ogy is less in dermatology comparing with other Pediatr Emerg Care. 1993;9(4):202-204.
discipline but their existence is not negligible. Physi- 8. Murr D, Bocquet H, Bachot N et al. Medical ac�vity in
cians working in emergency department must have a emergency outpa�ent department dermatology. Ann
some basic knowledge of this skin condi�ons and DermatolVenereol 2003; 130: 167–170,IndianJournal of
dermatologists should be well capable in managing Emergency Medicine 2018;4(3):147-153September2018
such emergency cases both in OPD and wards. 9. Isnard C, Ingen-Housz-Oro S, Fardet L et al. Dermato-
©2021 Bangladesh Academy of Dermatology www.jbadbd.com 23Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25 logical emergencies: evolu�on from 2008 to 2014 and nature of drug-related hospital admission: A 6-month perspec�ves. J Eur Acad Dermatol Venereol. 2017 observa�onal study in a ter�ary health care hospital. J Feb;31(2):274-279. doi: 10.1111/jdv.13860. Epub 2016 Pharmacol Pharmacother. 2011;2:17–20. Sep 29. PMID: 27681584. 23. Sultana A, Bhuiyan MSI, Mahmud MM Pa�ern of 10. Ansorge C, Miocic JM, von Bubnoff D et al. Resources Adverse Cutaneous Drug Reac�ons (ACDR) to Systemic spent on dermatological emergency pa�ents: A Drugs. Ur�caria, Angioedema, and Anaphylaxis twelve-month prospec�ve data collec�on from Germa- 2019;47(3):32-36. h�ps://doi.org/10.3329/bm- ny. Journal of the German Society of Dermatology: JDDG. j.v47i3.43496 2019 Oct;17(10):1018-1026. DOI: 10.1111/ddg.13922. 24. Modi KR, Patel NM, Solanki A et al. Evalua�on of 11. Lai-Kwon J, Weiland TJ, Chong AH et al. Which Emergency Dermatological Condi�ons: A Prospec�ve dermatological condi�ons present to an emergency Study. Indian Journal of Emergency Medicine. department in australia? Emerg Med Int. 2018;4(3):147-152. 2014;2014:463026. doi: 10.1155/2014/463026. 25. Sarkar R, Garg VK. Erythroderma in children. Indian J 12. Mitra D, Chopra A, Saraswat N et al. An Observa�on- Dermatol Venereol Leprol. 2010 Jul-Aug;76(4):341-7. al Study to Describe the Clinical Pa�ern of Dermatologi- doi: 10.4103/0378-6323.66576. PMID: 20657113. cal Emergencies from Emergency Department and Inten- 26. Nair PS, Moorthy PK, Yogiragan Y. A study of mortali- sive Care Unit: Our Experience from a Ter�ary Care ty in dermatology. Indian J Dermatol Venereol Leprol Hospital in Northern India. Indian Dermatol Online J. 2005;71:23-5. 2019;10(2):144-148. doi:10.4103/idoj.IDOJ_318_18 27. Miyashiro, D., Sanches, J.A. Erythroderma: a 13. Baibergenova A, Shear N Skin Condi�ons That Bring prospec�ve study of 309 pa�ents followed for 12 years in Pa�ents to Emergency Departments Archives of derma- a ter�ary center. Sci Rep 10, 9774 (2020). h�ps://- tology 147(1):118-20 doi.org/10.1038/s41598-020-66040-7 14. Drago F, Gasparini G, Signori A et al. Dermatological 28. Crochet J, Lepelley M, Yahiaoui N et al. Bradykinin consulta�ons in an observa�on unit of an emergency mechanism is the main responsible for death by isolated department in Italy. J Eur Acad Dermatol Venereol 2015; asphyxia�ng angioedema in France. Clin Exp Allergy. 29: 973–980 2019; 49: 252-254. 15. Priyanka CP, Amit SM, Sejal HT et al. Dermatological 29. Heng YK, Lee HY, Roujeau JC. Epidermal necrolysis: emergencies: a prospec�ve study in a ter�ary care hospi- 60 years of errors and advances. Br J Dermatol. tal, Gujarat, India . Int J Res Med. 2014; 3(4);90-95 2015;173:1250–1254 16. Wang E, Lim BL, Than KY. Dermatological condi�ons 30. Carson PJ, Hameed A, Ahmed AR. Influence of treat- presen�ng at an emergency department in Singapore. ment on the clinical course of pemphigus vulgaris. J Am Singapore Med J. 2009 Sep;50(9):881-4. PMID: Acad Dermatol 1996;34:645-52. 19787176. 31. Gemell CG. Staphylococcal scalded skin syndrome. J 17. Kim J, Cho HH, Hong JS et al. Skin condi�ons present- Med Microbiol 1995;43:318–27 ing in emergency room in Korea: an eight-year retrospec- 32. Puvanendran R, Huey JC, Pasupathy S. Necro�zing �ve analysis. J Eur Acad Dermatol Venereol.20132:49-8. fascii�s. Can Fam Physician. 2009;55(10):981-987. 18. Powell RJ, Leech SC, Till S et al. Bri�sh Society for 33. Urbaniak JR, O’Neil MT, Meyer LC. Purpura fulmi- Allergy and Clinical Immunology BSACI guideline for the nans. J bone Joint Surg Am. 1973;55:69–77. management of chronic ur�caria and angioedema. Clin 34. Abate MS, Ba�le LR, Emerson AN et al. Dermatologic Exp Allergy. 2015;45(3):547–565. doi: 10.1111/- Urgencies and Emergencies: What Every Pathologist cea.12494. Should Know. Arch Pathol Lab Med. 2019 19. Gaeta TJ, Clark S, Pelle�er AJ et al. Na�onal study of Aug;143(8):919-942. doi: 10.5858/arpa.2018-0239-RA. US emergency department visits for acute allergic Epub 2019 Feb 20. PMID: 30785787. reac�ons, 1993 to 2004.Gaeta TJ, Clark S, Pelle�er AJ, 35. Irvine C. “Skin failure”- a real en�ty: discussion Camargo CA Ann Allergy Asthma Immunol. 2007 Apr; paper. J R Soc Med 1991;84:412-3. 98(4):360-5. 36. Ladhani S, Evans RW Staphylococcal scalded skin 20. Pier J, Bingemann TA Ur�caria, Angioedema, and syndrome. Arch Dis Child 1998;78:85–88 Anaphylaxis. Pediatrics in Review Jun 2020, 41 (6) 37. Sehgal VN, Srivastava G, Sardara K. Erythroderma/ 283-292; DOI: 10.1542/pir.2019-0056 Exfolia�ve derma��s: a synopsis. Int J Dermatol. 2004 21. Nelson KM, Talbert RL. Drug-related hospital admis- Jan;65(2):100–102. sions. Pharmacotherapy. 1996;16:701–7. 38. Inamadar AC, Palit A. Acute skin failure: concept, 22. Singh H, Kumar BN, Sinha T et al. The incidence and causes, consequences and care. Indian J Dermatol ©2021 Bangladesh Academy of Dermatology www.jbadbd.com 24
Review ar�cle: Dermatological emergency and life threatening skin condi�ons. JBAD 2021; 1(1): 17-25 Venereol Leprol. 2005 Nov-Dec;71(6):379-85. doi: 10.4103/0378-6323.18007. PMID: 16394477. 39. Rothe MJ, Bialy TL, Grant-Kels JM. Erythroderma. Dermatol Clin 2000;18:405-15. 40. Nguyen T, Freedman J Dermatologic Emergencies: Diagnosing And Managing Life-Threatening Rashes. Emergency Medicine Prac�ce. 2002;4(2):1-27. 41. Palmieri TL, Greenhalgh DG, Saffle JR et al. A mul�- center review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twen�eth century. J Burn Care Rehabil. 2002 Mar-Apr;23(2):87-96. doi: 10.1097/00004630-200203000-00004. PMID: 11882797. ©2021 Bangladesh Academy of Dermatology www.jbadbd.com 25
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