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Life-Threatening Skin Rashes (cont.)

Diagnosis of Life-Threatening Skin Rashes

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. A history of having taken medications associated with SJS is not essential for the diagnosis. A history of a recent viral infection can be helpful in making the diagnosis. In some individuals, however, no cause for the development of SJS is found, resulting in a number of patients for whom the cause is without an identifiable cause (termed idiopathic).
    • 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. Like SJS a history of having taken medications associated with TEN is not essential for the diagnosis.
    • 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 three 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 dysfunction
      • 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.
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Read What Your Physician is Reading on Medscape

Toxic Epidermal Necrolysis »

Described in 1956 by Alan Lyell, toxic epidermal necrolysis (TEN) is a life-threatening skin disorder that is commonly drug-induced.

Read More on Medscape Reference »


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