Doctor's Notes on Life-Threatening Skin Rashes
Most skin rashes are not dangerous. However, there are some potentially life-threatening serious conditions that have a skin rash as a primary sign. These conditions include pemphigus vulgaris (PV), toxic epidermal necrolysis (TEN, also known as Stevens-Johnson syndrome or erythema multiforme major (EM)), drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, toxic shock syndrome (TSS), meningococcal infections, necrotizing fasciitis, and Rocky Mountain spotted fever (RMSF).
Conditions that cause life-threatening skin rashes usually have other associated symptoms and signs in addition to the skin rash. These symptoms depend on the cause of the condition and can include:
- itching or burning skin,
- muscle aches,
- sore throat,
- redness and warmth of the skin, and
- red spots in the mouth or eyes.
What Is the Treatment for Life-Threatening Skin Rashes?
Treatment of life-threatening skin rashes is directed at the underlying conditions. Severe bacterial infections require treatment with antibiotics, typically given intravenously. Some viral infections are treated with antiviral drugs.
In all cases of life-threatening conditions, hospitalization and supportive treatment are typically required. Supportive treatment includes intravenous fluids, oxygen or other respiratory support including mechanical ventilation, and medications to maintain adequate blood pressure. Other medications may also be given, depending on the specific cause of the condition.
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Necrotizing Fasciitis (Flesh-Eating Disease)Necrotizing fasciitis is a disease caused by flesh-eating bacteria. Symptoms and signs include pain, localized redness, warmth, and swelling, along with possible fever and chills. Over hours to days, the redness spreads rapidly, and the skin may become purplish in color. Treatment of necrotizing fasciitis should begin immediately. Treatment includes antibiotics and hyperbaric oxygen therapy.
Rocky Mountain Spotted FeverRocky Mountain spotted fever is a tick-borne disease. A bite from a tick infected by the Rickettsia rickettsi bacteria causes symptoms and signs that include nausea, vomiting, headache, muscle aches, fatigue, fever, rash, joint and abdominal pain, and diarrhea. Treatment with the antibiotic doxycycline is recommended in adults and children.
Skin Rashes in ChildrenSkin rashes in children may be categorized as bacterial, viral, life-threatening, fungal, and parasitic rashes. Oftentimes, the associated symptoms help establish the diagnosis. Treatment depends upon the type of rash and the severity of the signs and symptoms.
Toxic Shock SyndromeToxic shock syndrome (TSS) is a rare, life-threatening illness that is caused by toxins (poisons) that circulate in the bloodstream. Symptoms and signs include fever, headache, sore throat, cough, nausea and vomiting, diarrhea, and abdominal pain. Treatment involves finding and removing the source of infection, IV antibiotics, IV fluids, correcting electrolytes, and monitoring kidney and liver functions.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.