Dermatologic Emergencies


This post is part of a series developed in preparation for participation in ACEP SimWars. It contains a review of several prominent emergency medicine topics which may be relevant for board preparation. Unless otherwise cited, content is based on HippoEM videos.


  • Appearance: diffuse maculopapular, edematous plaques
  • Symptoms: known trigger, transient, pruritic
  • Management: remove trigger, epinephrine, glucagon


  • EM
    • Causes: drugs, HSV
    • Appearance: target lesions, symmetric, palm/sole involvement
    • Management: remove offending agent, supportive care
  • SJS (<10% TBSA)
    • Cause: drugs
    • Appearance: >2 mucous membranes
    • Findings: +Nikolsky
    • Symptoms: flu-like
    • Management: burn center, dermatology consult
  • TEN (>30% TBSA)
    • Management: IVIG, steroids, burn center, dermatology consult


  • Epidemiology: <6yo, older if immunosuppressed
  • Appearance: painful, diffuse erythema, bullae, no MM involvement
    • Stage 1: tender erythroderma
    • Stage 2: exfoliation
    • Stage 3: desquamation
  • Findings: +Nikolsky
  • Management: antibiotics (cephalosporin), no steroids

Rash Mnemonics

Palmar Rash

  • “sifting rocks scabbed Emma’s palms”
  • Syphilis (2°)
  • RMSF
  • Scabies
  • EM

Nikolsky Sign

  • SSSS
  • PV


  • RMSF
  • Meningococcemia
  • DIC
  • Endocarditis


  • Epidemiology: <20yo, dorm, military barracks
  • Appearance: diffuse petechiae, palpable purpura
  • Management: antibiotics, steroids

Necrotizing fasciitis

  • Symptoms: POOP, rapid progression
  • Appearance: bullae, crepitus, systemic toxicity
  • Management: surgery, antibiotics


  • Symptoms: flu-like
  • History: tick bite, camping/hiking
  • Appearance: wrist/ankle spreading inward (centrifugal), petechiae
  • Diagnosis: clinical, titers
  • Management: doxycycline (increased mortality if not treated)


  • Epidemiology: 40-60yo
  • Pathophysiology: autoantibodies (desmoglein), causes superficial epidermal separation (pemphigus for superficial)
  • Symptoms: painful oral blisters, small bullae
  • Findings: +Nikolsky
  • Management: steroids (methylprednisolone 1g IV), burn center


  • Epidemiology: >70yo
  • Pathophysiology: autoantibodies, deeper dermal layer (pemphigoid for deep)
  • Symptoms: not painful, no oral lesions
  • Findings: large, tense, unruptured bullae
  • Management: steroids