Life-threatening Skin Rashes

You must recognize these life-threatening skin rashes early and get the proper attention quickly. Call the doctor if your symptoms include any of the following:

Rash

• Any rash that is sudden in onset and covers a large part of the body Any rash that occurs shortly after starting a new medication Any rash that starts either shortly after a flulike illness begins or a rash that starts after a flulike illness goes away Mouth sores - Any mouth sores that make it difficult to drink clear liquids Red eyes - Any sudden onset of red, inflamed eyes, accompanied by a rash or other illness Dizziness or lightheadedness when standing

You should go to a hospital’s emergency department if you have any of the following symptoms:

• Rashes that begin to blister over large portions of the body surface or when large portions of skin begin to peel Fainting, or passing out Any mouth sores that are too painful to drink even small sips of liquids

Self-Care at Home

Because all of these disorders are life threatening, home care is limited. Seeing the signs and symptoms early and going to a doctor right away are the only acceptable actions. If left without treatment, many of the people with any of these disorders may die. While getting to the doctor, the following care for symptoms can be started:

Blisters

• Do not break blisters that are intact. As blisters break, do not attempt to peel away loose skin. Cover blisters with sterile gauze or clean sheets. Do not apply ointments or creams to blistered or raw skin.

Fever

• You may give acetaminophen(Tylenol) to control fever and help with some of the pain and discomfort.
• Do not attempt to bring fever down with cold-water soaks or baths. This makes the person shiver and may actually increase internal temperature.
• If the fever is severe, you may use towels soaked in lukewarm water to wipe down the parts of the body that are not blistered.

Red eyes

• Do not attempt to treat any rash that affects the eyes without seeking medical attention. Do not use drops of any kind.

Mouth ulcers or sores

• Do not use mouthwash or any oral rinses to treat mouth sores at home.
• Dehydration can occur if mouth sores are severe and pain limits the intake of fluids
• Frequent small sips of water or any sports drink should be encouraged to prevent or at least limit dehydration.

Follow-up

Each case and each disorder will need different follow-up care. The doctor responsible for your care while in the hospital will decide what sort of follow-up is best for you.

• Wound care: Many of the skin lesions will likely be healed or well on their way to healing by the time you are discharged from the hospital. Keep all healing wounds clean and dry. Use any medications or ointments only as prescribed by the doctor.
• Antibiotics: Antibiotics may be prescribed when you leave the hospital. Take all antibiotics as prescribed, until they are gone. Do not stop taking antibiotics, even if you are feeling better.
• Steroids: Some of these disorders may require long-term steroid pills. Others may only require steroids for a few days or weeks. The doctor may also prescribe a steroid taper—that is, gradually decreasing the amount of steroids you are taking over time, until you are off them completely. Take all steroids exactly as the doctor prescribes. Stopping them suddenly can cause serious side effects and may lead to rehospitalization.

Prevention

Prevention is often difficult, because few clear causes have been found for any of these diseases. A few general guidelines are suggested.

• Do not try to avoid every medicine thought to be associated with any of these disorders. Serious medication allergies are extremely rare. Simply avoid taking medications to which you have a known allergy. Always alert your doctor to potential medication allergies you may have.
• Many of the infections thought to cause these disorders are almost impossible to avoid and are virtually always harmless infections.
• Avoiding tampons can help prevent TSS. The super-absorbant tampons introduced to the market in the 1970s are no longer available in the US, and tampons now in the marketplace are considered safe. When using any tampons, however, change them frequently.

Outlook

These disorders pose a serious risk for death if they do not get treated. Early treatment and care in a hospital or intensive care unit greatly increases the chance of survival.

Pemphigus vulgaris:

Despite early treatment, 5-15% of people with PV will die. Delay in starting treatment makes death more likely. Many people require long-term steroid use to control the disease.

Stevens-Johnson syndrome:

Those with SJS who receive treatment have a 90% chance of survival.

Toxic epidermal necrolysis:

Even with treatment, 30-50% of people with TEN have a very poor outlook and may die.

Toxic shock syndrome:

With medical treatment, 92-95% of people will recover.

Staphylococcal scalded skin syndrome:

SSS has the most favorable chance of recovery. Only a small percentage of cases result in death.