Life-Threatening Skin Rashes (cont.)
Other Life-Threatening Skin Rashes Symptoms and Signs
- Toxic shock syndrome (TSS)
- TSS occurs in teens to young adults 15-34 years of age.
- Two-thirds of people with TSS are younger than 25 years of age.
- Four out of five are female.
- Symptoms begin up to two days before the onset of skin rash and include fever greater than 102 F, sore throat, headache, fatigue,
nausea, vomiting, and diarrhea.
- TSS may involve the mucous membranes with red, irritated eyes, and a beefy-red tongue.
- Dizziness or a lightheaded feeling when standing up is also common.
- Joints and eyelids also may swell.
- A diffuse red rash then rapidly appears that may cover most or all of the body.
- If you press on the red areas of skin, the skin will blanch, or turn white. Releasing pressure will cause the redness to return.
- The skin remains flat with no raised areas, bumps, or blisters.
- Other organ systems also are affected by TSS, and TSS may lead to kidney, liver, respiratory, and heart failure. The brain may also be involved leading to confusion or disorientation.
- Shock occurs when the cardiovascular system is unable to maintain blood pressure, leading to dizziness or lightheadedness when standing.
- The rash will usually disappear in about three to five days.
- During recovery, after the rash is gone, skin on the palms of the hands and soles of the feet begins to flake and peel off. In severe cases, fingernails, toenails, and hair may fall out. Other areas of skin may also begin to flake and peel.
- Staphylococcal scalded skin syndrome (SSSS)
- SSSS is a disease found in children, typically 6 months to 6 years of age.
- Initial symptoms include fever and irritability, and areas of skin may be tender before the rash breaks out.
- The rash in SSSS comes on suddenly and begins in places where your skin has creases: armpits, groin, neck, and around the mouth and eyes. It then quickly spreads to cover most or all of the body.
- The skin is red, warm, tender to touch, and has a sandpaper texture.
- The rash is similar to that found in scarlet fever, a less harmful disorder. The difference between scarlet fever and SSSS is that in SSSS the rash is painful to touch.
- About one day after the onset of the rash, the skin begins to wrinkle and form large, irregular, loose blisters.
- The blisters break open easily, and the outer layer of skin peels off in
sheets over the next three to five days.
- As the skin blisters and peels, it looks as if it has been scalded, which led to the name of the disorder. Raw skin underneath the blisters dries out quickly after the skin peels off and heals in the next 10-14 days.
- Unlike individuals with other skin reactions described herein, individuals with SSSS may not appear toxic. Rather, the skin reaction may be only a minor nuisance despite its appearance.
Timothy J. Rupp, MD, FACEP, FAAEM
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