Exams and Tests

Several of these disorders are difficult to diagnose in the emergency department. Blood tests, skin biopsies, and clinical presentation all play a factor in diagnosing each disorder. Doctors usually start treatment based on the symptoms and suspicion of one of these disorders and may not make a final diagnosis until after tests are done.

• A skin biopsy is taken using a special instrument designed to "punch out" a small round sample of skin.
  
  
  • Biopsy specimens are taken out of either normal skin near the rash or in an area of redness that has not yet blistered.
    
    
  • If skin biopsies are taken out of blistered areas, they are usually taken only from the skin forming the roof of the blister.
  
  
• Blood tests are sent for analysis to check for specific antibodies made by the body's natural immune system.
  
  
• Pemphigus vulgaris
  
  
  • Skin biopsy samples of the blistering skin and normal appearing skin next to blistering areas are tested.
    
    
  • Samples are stained to detect the antibodies that have attacked the proteins that hold together the outer layers of skin.
  
  
• Stevens-Johnson syndrome
  
  
  • Diagnosis is usually made based on symptoms of the rash typical to SJS, mucous membrane involvement, and use of medications that have been known to cause this disease.
    
    
  • Skin biopsy may also make diagnosis easier.
  
  
• Toxic epidermal necrolysis
  
  
  • TEN is thought to be a more severe form of SJS.
    
    
  • Diagnosis is made based on symptoms of a rash typical to TEN, mucous membrane involvement, and use of medications known to cause this disease.
    
    
  • Skin biopsy results show that the entire outer layer of skin has separated from the rest of the skin.
  
  
• Toxic shock syndrome
  
  
  • Diagnosis of TSS is based on the following symptoms: fever greater than 102°F, a diffuse red rash, systolic blood pressure less than 90 or fainting upon standing, no evidence of other disease that may be causing the symptoms.
    
    
  • A TSS diagnosis also requires the involvement of 3 or more other organ systems as evidenced by the following:
    
    
    • Vomiting or diarrhea
      
      
    • Muscle pain or blood test that shows enzyme levels consistent with breakdown of muscle
      
      
    • Inflammation of the mouth, throat, vagina, or eyes
      
      
    • Blood test showing evidence of kidney or liver disfunction
      
      
    • Disorientation or confusion
      
      
    • Heart failure
      
      
    • Respiratory failure
  
  
• Staphylococcal scalded skin syndrome
  
  
  • Diagnosis is almost always made based on symptoms.
    
    
  • Skin biopsy results are not always needed but, if performed, will show separation of the outer layer of skin.