Dermatological Emergencies
Retiform Purpura
This is a symptom of a serious disease causing occlusion of small arteries usually in the leg causing skin bleeding and loss of circulation.
The most common diseases causing retiform purpura:
- DIC, TTP, Warfarin or Heparin induced thrombosis
- Bacterial infections, endocarditis, atrial myxoma
Treatment is to treat the cause
![](http://medicalcareone.com/wp-content/uploads/2020/05/retform.png)
Erythema Multiforme
It is an immune reaction skin eruption characterized by the presence of target lesions with outer red ring and inner pale ring. It has 2 types:- Erythema Multiforme Minor: the rash typically appears on dace and limbs, it does not affect the mucous membranes, no fever or joint pain, usual tigger is Herpes or Mycoplasma infection or drug reaction.
- Erythema Multiforme Major: it is characterized by the same rash + mucosal involvement (oral ulcers), fever, malaise, joint pain and swelling.
![](http://medicalcareone.com/wp-content/uploads/2020/05/erythma.png)
Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)
- This is a very serious generalized skin and mucous membranes condition that complicates most of the time a drug use causing a widespread blistering and ulceration
- It is called SJS if only 10% of the body surface is affected.
- It is called TEN if it is >30%
- It is called SJS/TEN if it is >10% and <30%
- Symptoms start 1-3 weeks after drug ingestion onset
- It may start with fever and Flu symptoms
- Unlike Erythema Multiforme it tends to affect face and trunk
- Internal organs may be involved
Treatment: IV Steroids or Immunoglobulin + wounds care in ICU/Burn unit
![](http://medicalcareone.com/wp-content/uploads/2020/05/steven.png)
Drug Hypersensitivity Syndrome
- It is a severe life threatening medication reaction
- The most encountered culprit is Sulfa, Allopurinol and seizure Meds.
- Symptoms start 2-6 weeks after exposure with fever and Flu symptoms followed by rash and skin burning pain
- Rash start on face and spread to trunk (measles like eruption)
- Eventually the face will be swollen and red (the hallmark)
- Internal organs involvement may occur
- Mucous membranes can be affected but less common than SJS/TEN
- Treatment: Stop the drug and IV steroids with taper over weeks to months
![](http://medicalcareone.com/wp-content/uploads/2020/05/drug-hypersensitiviety-e1592197724174.png)
Erythroderma
- It causes diffuse redness of 80 to 90% of the body surface
- It is usually associated with itching , swelling, erosions, scaling and swollen lymph nodes.
- It can be idiopathic or worsening of atopic dermatitis Orr Psoriasis
Treatment involves IV hydration and Steroids and treatment of infection.
![](http://medicalcareone.com/wp-content/uploads/2020/05/eryth.png)
Acute Generalized Exanthematous Pustulosis
- It is rapid onset yellow blisters(pustules)
- The most common cause is antibiotic
- Most are self limited and resolves in 2 weeks
Treatment: stop the antibiotic, consider Steroids use
![](http://medicalcareone.com/wp-content/uploads/2020/05/acute-generalized-e1592197868882.png)