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.
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.
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.
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
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.