Life-Threatening Skin Rashes (cont.)
Timothy J. Rupp, MD, FACEP, FAAEM
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Life-Threatening Skin Rashes Symptoms
Pemphigus vulgaris (PV)
PV happens more commonly in adults 40-60 years of age, but it has been found in children as young as 3 years
of age and in adults as old as 89 years of age.
PV affects both women and men equally.
The painful blisters found in PV are irregularly shaped, elevated skin lesions, usually more than ½ inch across.
The blisters can form on either normal skin or reddened skin.
Lesions usually start in the mouth and may be found on the lips, tongue, throat, and the inside of the cheeks.
Painful blisters in the mouth make drinking and eating difficult.
Blisters then spread to the head, face, and armpits, before moving on to the rest of the body.
As they form, blisters are initially tense and filled with clear fluid.
If you press on the skin next to a blister, the blister will either extend or a new blister will form.
After two to three days, the blisters become loose, and the fluid within the blister becomes cloudy.
At this stage, the blisters break easily, leaving a very painful area of raw skin underneath that quickly crusts over.
These open sores are very susceptible to infection.
Because the blisters can cover a large portion of the body surface, infection can be severe and easily spread into the blood.
If not treated, these severe infections may lead to death.
Stevens-Johnson syndrome (SJS)
SJS occurs in all age groups but is more common among people 20-40 years of
SJS affects men twice as often as women.
The early symptoms include
fever, muscle and joint pains, generalized fatigue, and itching or burning sensations in the skin.
The SJS rash starts in the mucous membranes, usually of the mouth and eyes, and may involve other mucous membranes in severe cases.
Then the skin lesions common to SJS develop. These lesions are often called "target lesions" because they have a
white, bluish, or purple center surrounded by a circle of red.
These lesions start as reddened spots about 1 inch around and usually appear in clusters.
Although the rash may start anywhere on the body, it typically involves the feet, hands, and the front of the legs and arms more frequently than the chest, abdomen, or back.
The rash usually occurs on both sides of the body.
Within one to two days, the rash develops into the typical target lesion.
Blisters then form in the centers of the lesions and may itch or be painful.
Target lesions usually appear in successive crops over the body and may run together, forming one large lesion.
Toxic epidermal necrolysis (TEN)
TEN occurs in all age groups but normally affects adults.
TEN occurs twice as often in women as men.
TEN is thought to be a more severe form of SJS.
Early symptoms of fever, fatigue, joint and muscle pains,
cough, nasal congestion, and runny nose may be present along with general skin tenderness up to a week before the onset of skin rash.
Mouth lesions and conjunctivitis,
or red eyes, may be present one to two days before the skin rash occurs.
The skin rash usually starts on the face or genitals and rapidly moves to the rest of the body.
The skin becomes reddened and is painful to touch.
Large blisters can run together, and large sheets of skin peel from the body.
Eye involvement is serious, usually leads to pus drainage from the eyes, and may result in blindness.
On average in TEN, up to 50% of the body surface is affected.
The loss of skin leads to large amounts of fluid loss through exposed surfaces and increased risk for infection.
The rash may also be found in the linings of the respiratory and gastrointestinal tracts.
Without medical attention, TEN may result in death.
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