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Dermatologic Emergencies in Adults

Life-threatening cutaneous conditions including Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN), DRESS, acute generalized exanthematous pustulosis (AGEP), erythroderma, necrotizing fasciitis, purpura fulminans, pemphigus and angioedema requiring urgent multidisciplinary care.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Dermatologic Emergencies in Adults?

Dermatologic emergencies are skin disorders associated with significant morbidity and mortality requiring immediate diagnosis and intervention. Life-threatening severe cutaneous adverse reactions (SCARs) include Stevens-Johnson syndrome (SJS, < 10% body surface), SJS/TEN overlap (10–30%), toxic epidermal necrolysis (TEN, > 30%), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP).

Other dermatologic emergencies include erythroderma (> 90% body surface erythema with high-output failure, hypothermia, fluid loss), necrotizing fasciitis (LRINEC score > 6), purpura fulminans (DIC, protein C/S deficiency, meningococcal sepsis), severe pemphigus vulgaris with mucosal involvement, generalized pustular psoriasis, angioedema with airway compromise, and systemic mastocytosis with anaphylaxis.

Management requires rapid identification of the culprit (drug stopping for SCARs—antibiotics, anticonvulsants, allopurinol, NSAIDs are most common), supportive care in burn or intensive care units, fluid-electrolyte resuscitation guided by Parkland-modified formulas, wound care with non-adherent dressings, ophthalmologic and urologic mucosal monitoring, and targeted therapies (cyclosporine 3–5 mg/kg/day or anti-TNF etanercept for TEN, systemic corticosteroids ± IVIG/rituximab for pemphigus, anti-IL-36 spesolimab for generalized pustular psoriasis, antibiotics with surgical debridement for necrotizing fasciitis, epinephrine and bradykinin/C1-INH inhibitors for angioedema).

Symptoms

Painful skin, dusky erythema, atypical targetoid lesions (SJS/TEN warning)
Positive Nikolsky sign, sloughing of > 30% body surface (TEN)
Mucosal involvement: oral, ocular, genital, urethral
Generalized erythema with scaling and high-output cardiac state (erythroderma)
Rapidly spreading skin necrosis with crepitus and pain out of proportion (necrotizing fasciitis)
Stellate purpuric ecchymoses with limb ischemia (purpura fulminans)
Facial swelling, lip-tongue edema, stridor (angioedema)

Risk Factors

High-risk drugs: allopurinol (HLA-B*5801), carbamazepine (HLA-B*1502 in Asians), lamotrigine, sulfonamides, NSAIDs, abacavir (HLA-B*5701)
Recent infections: HSV, Mycoplasma, CMV reactivation in DRESS
Immunosuppression, HIV (5–10× SCARs risk)
Underlying autoimmune disease (pemphigus, lupus)
Diabetes, peripheral vascular disease, IV drug use (necrotizing fasciitis)
Coagulopathy, sepsis, neonatal status (purpura fulminans)
Genetic factors: HLA polymorphisms, slow-acetylator phenotype

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Painful skin with blistering or sheets of erythema after starting a new medication
  • Mucosal sores in eyes, mouth, genitals with skin rash
  • Fever > 39°C with diffuse rash and lymphadenopathy
  • Generalized red, peeling skin with hypothermia or hypotension
  • Severe skin pain disproportionate to visible findings
  • Sudden facial, lip or tongue swelling with breathing difficulty
  • Spreading purple skin lesions with limb pain or numbness

Treatment Methods

01
Immediate withdrawal of culprit drug; calculate SCORTEN, ALDEN, RegiSCAR scores
02
Burn unit / ICU admission for SJS/TEN and erythroderma; non-adherent dressings, careful wound care, ophthalmology consult, daily ocular lubrication
03
Cyclosporine 3–5 mg/kg/day × 7–14 days for TEN (mortality benefit) OR etanercept 50 mg SC × 1–2 doses; consider IVIG 2 g/kg
04
Systemic corticosteroids 1 mg/kg/day prednisone for AGEP, DRESS (taper over months)
05
High-dose corticosteroids ± rituximab + IVIG for severe pemphigus vulgaris
06
Spesolimab (anti-IL-36R) IV for generalized pustular psoriasis flare
07
Surgical debridement + broad-spectrum antibiotics (piperacillin-tazobactam + clindamycin + vancomycin) for necrotizing fasciitis; protein C concentrate for purpura fulminans; epinephrine, C1-INH or icatibant for angioedema

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.