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Feature Article

Dermatological emergencies: how to recognise them and what to do

Shreya Dixit, Supriya Venugopal, Gayle Fischer, Alan Cooper
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Abstract

Emergencies in dermatology are uncommon but can cause significant long-term morbidity or even be life-threatening. Three patients illustrate the need for early recognition and urgent referral for treatment of staphylococcal scalded skin syndrome, toxic epidermal necrolysis and pyoderma gangrenosum.

Key Points

  • Dermatological emergencies are uncommon but can cause devastating complications if not recognised and treated early.
  • Many patients require early referral to a tertiary hospital with a dermatology department.
  • Staphylococcal scalded skin syndrome is a spot diagnosis in children aged under 5 years and responds well to flucloxacillin.
  • In toxic epidermal necrolysis, identification and cessation of the causative drug is key, which requires a careful history of any prescribed and over-the-counter medications the patient is taking.
  • In pyoderma gangrenosum, clues to the diagnosis include pain disproportionate to lesion morphology and rapid progression; however, pyoderma gangrenosum is a diagnosis of exclusion and infective causes must be ruled out.

    Picture credits (top to bottom): Toxic epidermal necrolysis © Phototake RM/Dennis Kunkel Microscopy, Inc; Pyoderma © Science Source/Biophoto Associates; Staphylococcus aureus © Science Photo Library RM/Steve Gschmeissner (all from Diomedia.com).

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