Emergency Medicine

112 General Medical Emergencies

Skin Disorders

The vast majority of skin disorders are managed by GPs and the dermatology
department. However, some patients may present as emergencies with blistering,
itching or purpuric conditions. Exanthematous diseases are common in children
and young adults, and malignant melanoma particularly in areas of high
sunshine.

Blistering (vesicobullous) conditions

DIAGNOSIS

1 Common causes:

(i) Viral:

(a) herpes zoster

(b) herpes simplex.

(ii) Impetigo.

(iii) Scabies.

(iv) Insect bites and papular urticaria.

(v) Bullous eczema and pompholyx.

(vi) Drugs – sulphonamides, penicillin, barbiturates.

2 Less common causes:

(i) Erythema multiforme minor (1–2 cm ‘target lesions’ only) or

erythema multiforme major (‘target lesions’ rash, plus one

mucous membrane involved) due to:

(a) Mycoplasma pneumonia

(b) herpes simplex

(c) drugs – sulphonamides and penicillins

(d) idiopathic (50%).

(ii) Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis

(TEN) causing epidermal detachment with mucosal erosions due

to:

(a) drugs such as anticonvulsants, sulphonamides, NSAIDs and

penicillins.

(iii) Staphylococcal scalded-skin syndrome (SSSS) usually in children.

(iv) Dermatitis herpetiformis (gluten sensitivity).

(v) Pemphigus and pemphigoid.

3 Rare causes:

(i) Porphyria cutanea tarda.

(ii) Epidermolysis bullosa (congenital).

MANAGEMENT

1 Refer patients with widespread or potentially life-threatening blistering

immediately to the dermatology team or medical team.