1887
Volume 2025, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Dermatologic emergencies are frequently missed in emergency department (ED) visits globally. Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), necrotizing fasciitis (NF), disseminated infections, and severe allergic reactions can rapidly progress to systemic complications, requiring prompt diagnosis and intervention. Despite their critical nature, many emergency healthcare providers lack adequate training in recognizing and managing life-threatening dermatologic conditions.

To explore the prevalence, classification, and management strategies of dermatologic emergencies in emergency medicine settings.

It is a narrative review. The duration of the study spanned 6 months. A structured search strategy was applied across major electronic databases, including PubMed, Scopus, and Google Scholar. Qualitative thematic analysis was used to categorize studies on dermatologic emergencies, identifying key themes, critical appraisals, gaps in knowledge, and opportunities for future research.

Among 127 studies reviewed, burns comprised 4% to 7% of dermatologic ED cases, stings and bites 6%, and allergic reactions 22%, with 4% progressing to anaphylaxis. NF and TEN showed mortality rates of 24% to 34% and 25% to 35%, respectively. Systemic corticosteroids were used in 79% of immunologic emergencies, and antibiotics in 92% of infectious cases. Pediatric and geriatric patients accounted for 18% and 26% of cases. Prevention strategies were discussed in 41% of studies.

Dermatologic emergencies, though infrequent, carry high morbidity and mortality. Early recognition, multidisciplinary management, and preventive strategies are essential. Improved education and training of emergency and critical care physicians are crucial to optimizing patient outcomes.

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2025-09-23
2025-12-05

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References

  1. Kilic D, Yigit O, Kilic T, Buyurgan CS, Dicle O. Epidemiologic characteristics of patients admitted to emergency department with dermatological complaints; a retrospective cross sectional study. Arch Acad Emerg Med. 2019 Aug; 7:(1):e47
    [Google Scholar]
  2. Kaye KS, Petty LA, Shorr AF, Zilberberg MD. Current Epidemiology, Etiology, and Burden of Acute Skin Infections in the United States. Clin Infect Dis. 2019 Apr; 68:(Suppl 3):S193–S9. https://doi.org/10.1093/cid/ciz002
    [Google Scholar]
  3. Hassan I, Rather PA. Emergency dermatology and need of dermatological intensive care unit (DICU). J Pak Assoc Dermatol. 2013 Jan-Mar; 23:(1):71–82
    [Google Scholar]
  4. Badia M, Casanova JM, Serviá L, Montserrat N, Codina J, Trujillano J. Dermatological manifestations in the intensive care unit: a practical approach. Crit Care Res Pract. 2020 Sep; 2020:9729814.https://doi.org/10.1155/2020/9729814
    [Google Scholar]
  5. Davidovici BB, Wolf R. Emergencies in dermatology: diagnosis, classification and therapy. Exp Rev Dermatol. 2007; 2:(5):549–62. https://doi.org/10.1586/17469872.2.5.549
    [Google Scholar]
  6. Karlsson V, Bäcke P, Björkman L, Holmgren K, Ingelsson L, Blomqvist YT. Protocol to support skin-to-skin care and closeness between parents and neonates in the NICU. J Obstet Gynecol Neonatal Nurs. 2025 Mar; 54:(2):249–57.https://doi.org/10.1016/j.jogn.2024.09.004
    [Google Scholar]
  7. Usatine RP, Sandy N. Dermatologic emergencies. Am Fam Physician. 2010 Oct; 82:(7):773–80
    [Google Scholar]
  8. Kedia A, Ranugha PSS, Chethana GS, Kanthraj GR. Severity grading of dermatological emergencies based on comorbidities and systemic involvement: an observational study. Arch Dermatol Res. 2023 Oct; 315:(8):2333–8.https://doi.org/10.1007/s00403-023-02615-4
    [Google Scholar]
  9. Alshibani A, Alagha SO, Alshammari AJ, Alshammari KJ, Alghamdi AS, Nagshabandi KN. Dermatology-related emergency department visits in Tertiary Care Center in Riyadh, Saudi Arabia: a descriptive study. Healthcare (Basel). 2024 Nov; 12:(23):2332.https://doi.org/10.3390/healthcare12232332
    [Google Scholar]
  10. Sultana S, Umapathy V, Rodriguez D. Dermatologic emergencies: a case series. Kauverian Med J. 2024; 1:(11):7–12.
    [Google Scholar]
  11. Algarni AS, Alshiakh SM, Alghamdi SM, Alahmadi MA, Bokhari AW, Aljubayri SN, et al. From rash decisions to critical conditions: a systematic review of dermatological presentations in emergency departments. Diagnostics (Basel). 2025 Mar; 15:(5):614.https://doi.org/10.3390/diagnostics15050614
    [Google Scholar]
  12. Wolf R, Parish LC. Life-threatening skin diseases: part I. Clin Dermatol. 2005 Mar-Apr; 23:(2):131–3.https://doi.org/10.1016/j.clindermatol.2004.06.017
    [Google Scholar]
  13. Temiz SA, Ozer I, Ataseven A. Dermatologic emergencies. Selcuk Univ Med J. 2020 Jun; 36:(2):157–67.https://doi.org/10.30733/std.2020.01115
    [Google Scholar]
  14. Inamadar AC, Palit A. Acute skin failure: concept, causes, consequences and care. Indian J Dermatol Venereol Leprol. 2005; 71:(6):379–85. https://doi.org/10.4103/0378-6323.18007
    [Google Scholar]
  15. Altammami GS, Alswayed SK, AlJasser MI, Alkhodair RA. Dermatological conditions in the intensive care unit at a tertiary care hospital in Riyadh, Saudi Arabia. Saudi Med J. 2024 Aug; 45:(8):834–9.https://doi.org/10.15537/smj.2024.45.8.20240479
    [Google Scholar]
  16. Parker ER, Mo J, Goodman RS. The dermatological manifestations of extreme weather events: a comprehensive review of skin disease and vulnerability. J Clim Change Health. 2022 Oct; 8:100162. https://doi.org/10.1016/j.joclim.2022.100162
    [Google Scholar]
  17. Vehe RK, Riskalla MM. Collagen vascular diseases: SLE, dermatomyositis, scleroderma, and MCTD. Pediatr Rev. 2018 Oct; 39(10):501–15.https://doi.org/10.1542/pir.2017-0262
    [Google Scholar]
  18. Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, et al. Erythroderma in adults: a report of 80 cases. Int J Dermatol. 2005 Sep; 44:(9):731–5.https://doi.org/10.1111/j.1365-4632.2004.02100.x
    [Google Scholar]
  19. Smith D, Bowden T. Using the ABCDE approach to assess the deteriorating patient. Nurs Stand. 2017 Nov; 32:(14):51–63.https://doi.org/10.7748/ns.2017.e11030
    [Google Scholar]
  20. Pearce PF, Ferguson LA, George GS, Langford CA. The essential SOAP note in an EHR age. Nurse Pract. 2016 Feb; 41:(2):29–36.https://doi.org/10.1097/01.NPR.0000476377.35114.d7
    [Google Scholar]
  21. van Schothorst J, van den Brand CL, Gaakeer MI, Wallenburg I. The role of emergency physicians in the institutionalization of emergency medicine. Eur J Emerg Med. 2017 Aug; 24:(4):301–7.https://doi.org/10.1097/MEJ.0000000000000346
    [Google Scholar]
  22. Pătrașcu AI, Vâță Pătrașcu AI, Vâță D, Temelie-Olinici D, Mocanu M, Guguluș DL, Marinescu M, et al. Skin lesions with loss of tissue and cutaneous-onset sepsis: the skin infection-sepsis relationship. Diagnostics (Basel). 2024 Mar; 14:(6):659.https://doi.org/10.3390/diagnostics14060659
    [Google Scholar]
  23. Hines AS, Zayas J, Wetter DA, Bridges AG, Camilleri MJ, McEvoy MT, et al. Retrospective analysis of 450 emergency department dermatology consultations: an analysis of in-person and teledermatology consultations from 2015 to 2019. J Telemed Telecare. 2021 Jun:1357633x211024844. https://doi.org/10.1177/1357633x211024844
    [Google Scholar]
  24. Broadis E, Chokotho T, Borgstein E. Paediatric burn and scald management in a low resource setting: a reference guide and review. Afr J Emerg Med. 2017; 7:(Suppl):S27–S31. https://doi.org/10.1016/j.afjem.2017.06.004
    [Google Scholar]
  25. Saaiq M. Presentation and management outcome of childhood scald burns managed with hydrocolloid dressings compared with silver sulphadiazine dressings. Ann Burns Fire Disasters. 2023 Jun; 36:(2):158–64
    [Google Scholar]
  26. Olaitan P, Olaitan J. Burns and scalds--epidemiology and prevention in a developing country. Niger J Med. 2005 Jan-Mar; 14:(1):9–16.https://doi.org/10.4314/njm.v14i1.37128
    [Google Scholar]
  27. Krau SD. Bites and stings: epidemiology and treatment. Crit Care Nurs Clin North Am. 2013 Jun; 25:(2):143–50.https://doi.org/10.1016/j.ccell.2013.02.008
    [Google Scholar]
  28. Warrell DA. Venomous bites, stings, and poisoning: an update. Infect Dis Clin North Am. 2019 Mar; 33:(1):17–38.https://doi.org/10.1016/j.idc.2018.10.001
    [Google Scholar]
  29. Patil A, Chagi A, Poojari PG, Rashid M, Shivashankar KN, Thunga G, et al. Clinical characteristics, management, outcome, and cost of stings and bites in patients admitted to a tertiary care teaching hospital. Toxicol Res (Camb). 2024 Jan; 13:(1):tfae006.https://doi.org/10.1093/toxres/tfae006
    [Google Scholar]
  30. Al Abri S, Al Rumhi M, Al Mahruqi G, Shakir AS. Scorpion sting management at tertiary and secondary care emergency departments. Oman Med J. 2019 Jan; 34:(1):9–13.https://doi.org/10.5001/omj.2019.02
    [Google Scholar]
  31. Singer E, Zodda D. Allergy and anaphylaxis: principles of acute emergency management. Emerg Med Pract. 2015 Aug; 17:(8):1–19; quiz 20
    [Google Scholar]
  32. Duffey H, Leonard J, Mistry RD. Variation in diagnosis and management of allergic reactions among emergency medicine and allergy immunology providers. Allergy Asthma Proc. 2023 Jan; 44:(1):51–8.https://doi.org/10.2500/aap.2023.44.220088
    [Google Scholar]
  33. Venter C, Sicherer SH, Greenhawt M. Management of peanut allergy. J Allergy Clin Immunol Pract. 2019 Feb; 7:(2):345–55.e2.https://doi.org/10.1016/j.jaip.2018.10.043
    [Google Scholar]
  34. Macdougall JD, Burks AW, Kim EH. Current insights into immunotherapy approaches for food allergy. Immunotargets Ther. 2021 Jan; 10:1.https://doi.org/10.2147/itt.S266257
    [Google Scholar]
  35. Mitra D, Chopra A, Saraswat N, Agarwal R, Kumar S. An observational study to describe the clinical pattern of dermatological emergencies from emergency department and intensive care unit: our experience from a Tertiary Care Hospital in Northern India. Indian Dermatol Online J. 2019 Mar-Apr; 10:(2):144–8.https://doi.org/10.4103/idoj.IDOJ_318_18
    [Google Scholar]
  36. Guliyeva G, Huayllani MT, Sharma NT, Janis JE. Practical review of necrotizing fasciitis: principles and evidence-based management. Plast Reconstr Surg Glob Open. 2024 Jan; 12:(1):e5533.https://doi.org/10.1097/gox.0000000000005533
    [Google Scholar]
  37. Ahmadzada S, Rao A, Ghazavi H. Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2022 Aug; 30:(4):270–5. https://doi.org/10.1097/moo.0000000000000820
    [Google Scholar]
  38. Goh T, Goh L, Ang C, Wong C. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014 Jan; 101:(1):e119–e25.https://doi.org/10.1002/bjs.9371
    [Google Scholar]
  39. Zhang Q, Shaikh AR, Yoon T, Shah S, Mahoney JW. The reflection on the management of toxic epidermal necrolysis in the community setting: an internist’s perspective. Cureus. 2021 Jan; 13:(1):e13042.https://doi.org/10.7759/cureus.13042
    [Google Scholar]
  40. Frederiks AJ, Kumarasinghe SP, Wood F, Rowe S, Cunneen T, Raby E, et al. Toxic epidermal necrolysis in adult patients: experience from the West Australian Collaboration. Australas J Dermatol. 2022 Nov; 63:(4):437–51. https://doi.org/10.1111/ajd.13903
    [Google Scholar]
  41. Cabañas Weisz LM, Miguel Escuredo I, Ayestarán Soto JB, García Gutiérrez JJ. Toxic epidermal necrolysis (TEN): Acute complications and long-term sequelae management in a multidisciplinary follow-up. J Plast Reconstr Aesthet Surg. 2020 Feb; 73:(2):319–27.https://doi.org/10.1016/j.bjps.2019.07.015
    [Google Scholar]
  42. Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care (New Rochelle). 2015 Sep; 4:(9):560–82.https://doi.org/10.1089/wound.2015.0635
    [Google Scholar]
  43. Dhivya S, Padma VV, Santhini E. Wound dressings - a review. Biomedicine (Taipei). 2015 Dec; 5:(4):22.https://doi.org/10.7603/s40681-015-0022-9
    [Google Scholar]
  44. Coltart G, Fityan A. Acute dermatological emergencies. Medicine. 2021 Jan; 49:(3):173–8.https://doi.org/10.1016/j.mpmed.2020.12.011
    [Google Scholar]
  45. Terreehorst I, Reitsma S, Cohn DM. Current treatment of angioedema induced by ACE inhibitors. Curr Treat Options Allergy. 2019 Feb; 6:(1):18–26.https://doi.org/10.1007/s40521-019-0203-y
    [Google Scholar]
  46. Patel T, Quow K, Cardones AR. Management of infectious emergencies for the inpatient dermatologist. Curr Dermatol Rep. 2021; 10:(4):232–42. https://doi.org/10.1007/s13671-021-00334-5
    [Google Scholar]
  47. Falodun O, Ogunbiyi A. Dermatological emergencies: current trends in management. Ann Ib Postgrad Med. 2010; 4:(2).https://doi.org/10.4314/AIPM.V4I2.55216
    [Google Scholar]
  48. Ramrakha P, Moore K, Sam A. Dermatological emergencies. Oxford Handbook of Acute Medicine. 12. 3. Oxford University Press; 2019. p. 691–710. https://doi.org/10.1093/med/9780198797425.003.0012
    [Google Scholar]
  49. Ingen-Housz-Oro S, Mirkamali A, Valeyrie-Allanore L, Chosidow O, Wolkenstein P. [Activity report on a rapid post-emergency consultation for the management of dermatological emergencies [corrected]]. Ann Dermatol Venereol. 2010 Aug-Sep; 137:(8–9):519–22.https://doi.org/10.1016/j.annder.2010.06.024
    [Google Scholar]
  50. Hassan I, Anwar P. Pediatric dermatological emergencies: an overview. J Pediat Sci. 2013 Nov; 5:1–14
    [Google Scholar]
  51. Gruver JR, Kirkorian AY. Pediatric dermatologic emergencies. Curr Opin Pediatr. 2024 Dec; 36:(6):720–6.https://doi.org/10.1097/mop.0000000000001408
    [Google Scholar]
  52. Van Damme N, Van den Bussche K, De Meyer D, Van Hecke A, Verhaeghe S, Beeckman D. Independent risk factors for the development of skin erosion due to incontinence (incontinence-associated dermatitis category 2) in nursing home residents: results from a multivariate binary regression analysis. Int Wound J. 2017 Oct; 14:(5):801–10.https://doi.org/10.1111/iwj.12699
    [Google Scholar]
  53. Wallis M, Marsden E, Taylor A, Craswell A, Broadbent M, Barnett A, et al. The Geriatric Emergency Department Intervention model of care: a pragmatic trial. BMC Geriatr. 2018 Dec; 18:(1):297.https://doi.org/10.1186/s12877-018-0992-z
    [Google Scholar]
  54. Aksoy Sarac G, Emeksiz MAC, Acar O, Nazlican E, Tanacan E, Nayir T. Retrospective analysis of dermatological diseases in geriatric patients during dermatology outpatient department visits. Dermatol Pract Concept. 2022 Jul; 12:(3):e2022145.https://doi.org/10.5826/dpc.1203a145
    [Google Scholar]
  55. Zirwas MJ, Holder JL. Patient education strategies in dermatology: part 2: methods. J Clin Aesthet Dermatol. 2009 Dec; 2:(12):28–34
    [Google Scholar]
  56. Armstrong G, Headrick L, Madigosky W, Ogrinc G. Designing education to improve care. Jt Comm J Qual Patient Saf. 2012 Jan; 38:(1):5–14.https://doi.org/10.1016/s1553-7250(12)38002-1
    [Google Scholar]
  57. Washington KT, Meadows SE, Elliott SG, Koopman RJ. Information needs of informal caregivers of older adults with chronic health conditions. Patient Educ Couns. 2011 Apr; 83:(1):37–44.https://doi.org/10.1016/j.pec.2010.04.017
    [Google Scholar]
  58. Herndon J, Chaney M, Carden D. Health Literacy and Emergency Department Outcomes: A Systematic Review. Ann Emerg Med. 2011 Apr; 57:(4):334–45.https://doi.org/10.1016/j.annemergmed.2010.08.035
    [Google Scholar]
  59. Liang SY, Theodoro DL, Schuur JD, Marschall J. Infection prevention in the emergency department. Ann Emerg Med. 2014 Sep; 64:(3):299–313.https://doi.org/10.1016/j.annemergmed.2014.02.024
    [Google Scholar]
  60. Mulac A, Mathiesen L, Taxis K, Gerd Granås A. Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations. BMJ Qual Saf. 2021 Dec; 30:(12):1021–30.https://doi.org/10.1136/bmjqs-2021-013223
    [Google Scholar]
  61. Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of safety: impact on improvement in infection prevention process and outcomes. Curr Infect Dis Rep. 2020; 22:(12):34. https://doi.org/10.1007/s11908-020-00741-y
    [Google Scholar]
  62. Kamat S, O’Hagan R, Brahe C, Hardy CL, Shrivastava V, Grant-Kels JM, et al. Ethical issues regarding dermatopathology care for service-members: a review. Dermatopathology (Basel). 2024 Sep; 11:(4):253–65.https://doi.org/10.3390/dermatopathology11040027
    [Google Scholar]
  63. Ghaith S, Moore GP, Colbenson KM, Lindor RA. Charting practices to protect against malpractice: case reviews and learning points. West J Emerg Med. 2022 Apr; 23:(3):412–7.https://doi.org/10.5811/westjem.2022.1.53894
    [Google Scholar]
  64. Dresser R, Frader J. Off-label prescribing: a call for heightened professional and government oversight. J Law Med Ethics. 2009 Fall; 37:(3):476–86, 396.https://doi.org/10.1111/j.1748-720X.2009.00408.x
    [Google Scholar]
  65. Munawar T, Ismail F, Mehmood Qadri H, Haq AU, Munawar A, Zahid AS, et al. Practices of informed consent for emergency procedures at a Tertiary Care Hospital in Lahore, Pakistan. Cureus. 2023 Dec; 15:(12):e50322.https://doi.org/10.7759/cureus.50322
    [Google Scholar]
  66. Krist AH, Tong ST, Aycock RA, Longo DR. Engaging patients in decision-making and behavior change to promote prevention. Stud Health Technol Inform. 2017; 240:284–302
    [Google Scholar]
  67. Minei A, Kaipu S. Respect for patients’ right to autonomy. J Health Sci. 2020 Jun; 8:(3):100–112.https://doi.org/10.17265/2328-7136/2020.03.004
    [Google Scholar]
  68. Kedia A, Ranugha PSS, Chethana GS, Kanthraj GR. Severity grading of dermatological emergencies based on comorbidities and systemic involvement: an observational study. Arch Dermatol Res. 2023 Oct; 315:(8):2333–8.https://doi.org/10.1007/s00403-023-02615-4
    [Google Scholar]
  69. Shojaei P, Vlahu-Gjorgievska E, Chow Y-W. Security and privacy of technologies in health information systems: a systematic literature review. Computers. 2024 Jan; 13:(2):41.https://doi.org/10.3390/computers13020041
    [Google Scholar]
  70. Basil NN, Ambe S, Ekhator C, Fonkem E. Health records database and inherent security concerns: a review of the literature. Cureus. 2022 Oct; 14:(10):e30168.https://doi.org/10.7759/cureus.30168
    [Google Scholar]
  71. Mennella C, Maniscalco U, De Pietro G, Esposito M. Ethical and regulatory challenges of AI technologies in healthcare: a narrative review. Heliyon. 2024 Feb; 10:(4):e26297. https://doi.org/10.1016/j.heliyon.2024.e26297
    [Google Scholar]
  72. Quazi S. Artificial intelligence and machine learning in precision and genomic medicine. Med Oncol. 2022 Jun; 39:(8):120.https://doi.org/10.1007/s12032-022-01711-1
    [Google Scholar]
  73. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: capabilities, features, barriers, and applications. Sens Int. 2021; 2:100117. https://doi.org/10.1016/j.sintl.2021.100117
    [Google Scholar]
  74. Hermida MD. Use of biologic agents in cutaneous emergencies. In: Group TF, editor. Emergency Dermatology. 2 ed. Boca Raton: CRC Press; 2017. p. 46–56. https://doi.org/10.1201/9781315160498
    [Google Scholar]
  75. Jo H, Brito S, Kwak BM, Park S, Lee M-G, Bin B-H. Applications of mesenchymal stem cells in skin regeneration and rejuvenation. Int J Mol Sci. 2021 Feb; 22:(5):2410.https://doi.org/10.3390/ijms22052410
    [Google Scholar]
  76. Lambraki IA, Cousins M, Graells T, Léger A, Abdelrahman S, Desbois AP, et al. Governing Antimicrobial Resistance (AMR) in a changing climate: a participatory scenario planning approach applied to Sweden in 2050. Front Public Health. 2022 Jul; 10:831097.https://doi.org/10.3389/fpubh.2022.831097
    [Google Scholar]
  77. Hunt B, Ruiz A, Pogue B. Smartphone-based imaging systems for medical applications: a critical review. J Biomed Opt. 2021 Apr; 26:(4):040902.https://doi.org/10.1117/1.JBO.26.4.040902
    [Google Scholar]
  78. Muir J, Xu C, Paul S, Staib A, McNeill I, Singh P, et al. Incorporating teledermatology into emergency medicine. Emerg Med Australas. 2011 Oct; 23:(5):562–8.https://doi.org/10.1111/j.1742-6723.2011.01443.x
    [Google Scholar]
  79. Maleki Varnosfaderani S, Forouzanfar M. The role of AI in hospitals and clinics: transforming healthcare in the 21st century. Bioengineering (Basel). 2024 Mar; 11:(4):337.https://doi.org/10.3390/bioengineering11040337
    [Google Scholar]
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