Emergency dermatology and need of dermatological intensive care unit (DICU)
Keywords:
Dermatological emergencies, acute skin failure, dermatological intensive care unit (DICU).Abstract
Dermatological emergencies comprise diseases with severe alterations in structure and function of the skin, with some of them leading to acute skin failure that demands early diagnosis, hospitalization, careful monitoring and multidisciplinary intensive care to minimize the associated morbidity and mortality. Prompt intensive management of acute skin failure in the ICU on the lines of 100% burns is mandatory; clearly establishing the necessity of a dedicated intensive care unit comprising of well synchronized team of dermatologist, internist, pediatrician, critical care physician and skilled nursing staff. In this article, we review the literature and discuss the major causes of dermatological emergencies, some of which lead to acute skin failure and lay stress for their management in ICU like set up attached to dermatology department itself, i.e., dermatological intensive care unit (DICU), so that such emergencies may be dealt with more effectively and without wastage of time. DICU should be equipped to such an extent that it provides initial, immediate and necessary support and it need not be as advanced and sophisticated as cardiac, surgical or neonatal ICU.ÂReferences
Trott AT. Emergency Medicine. In: Hamilton GC, Sanders A, Strange GS et al., Editors. Emergency Medicine: An Approach to Clinical Problem Solving. 2nd ed. Philadelphia, PA: Saunders; 2003. p. 185-206.
Symvoulakis EK, Krasagakis K, Komninos ID et al. Primary care and pattern of skin diseases in a Mediterranean island. BMC Fam Pract 2006;7:6.
Gupta S, Sandhu K, Kumar B. Evaluation of emergency dermatological consultations in a tertiary care centre in North India. J Eur Acad Dermatol Venereol. 2003;17:303-5.
Vaishampayan SS, Sharma YK, Das AL, Verma R. Emergencies in dermatology: Acute skin failure. MJAFI. 2006;62:56-9.
Holden CA, Berth-Jones J. Erythroderma. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology. 7th ed. Oxford: Blackwell science; 2004. P. 17.48.
Rongioletti F, Borensteim M, Kisner R, Kendel F. Erythrodermic, recalcitrant psoriasis: Clinical resolution with infliximab. J Dermatol. 2003;14:222-5.
Satyapal S, Mehta G, Dhurat R et al. Staphylococcal scalded skin syndrome. Indian J Paediatr. 2002;69:899-901.
Jaffer AN, Brodell RT. Exfoliative dermatitis. Post Grad Med. 2005;117:49-51.
Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol Leprol. 2010;76:341-7.
Ragunatha S, Inamadar AC. Neonatal dermatological emergencies. Indian J Dermatol Venereol Leprol. 2010;76:328-40.
Hoeger PH, Harper JI. Neonatal erythroderma: Differential diagnosis and management of the "red baby". Arch Dis Child. 1998;79:186-91.
Kumar S, Sehgal VN, Sharma RC. Common genodermatoses. Int J Dermatol. 1996;35:685-94.
Bonifazi E, Meneghini CL. Atopic eczema in the first six months of life. Acta Derm Venereol Suppl (Stockh) 1989;144:20-2.
Sarkar R, Basu S, Sharma RC. Neonatal and infantile erythroderma. Arch Dermatol. 2001;137:822-3.
Chang SE, Choi JH, Koh JK. Congenital erythrodermic psoriasis. Br J Dermatol. 1999;140:538-9.
Nicolis GD, Helwig EB. Exfoliative dermatitis: A clinic pathologic study of 135 cases. Arch Dermatol. 1973;108:788-97.
Sehgal VN, Srivastava G. Exfoliative dermatitis: a prospective study of 80 patients. Dermatologica. 1986;173:278-84.
Breathnach SM. Drug reactions. In: Champion RH, Burton I, Burns DA Breathach SM editors. Textbook of Dermatology. 4th ed. Oxford: Blackwell Scientific Publications; 1988. p. 3370-1.
Danno K, Kume M, Ohta M et al. Erythroderma with generalized lymphadenopathy induced by phenytoin. J Dermatol. 1989;16:392-6.
Kucukguclu S, Tuncok Y, Ozkan H et al. Multiple dose activated charcoal in an accidental vancomycin overdose. J Toxicol Clin Toxicol. 1996;34:83-6.
Pruszkowski A, Bodemer C, Fraitag S et al. Neonatal and infantile erythroderma: A retrospective study of 51 patients. Arch Dermatol. 2000;136:875-80.
De Saint Basile G, Le Deist F, de Villartay JP et al. Restricted heterogeneity of T lymphocytes in combined immunodeficiency with hypereosinophilia (Omenn's syndrome). J Clin Invest. 1991;84:1352-9.
Alain G, Carrier C, Beaumier L et al. In utero acute graft versus host disease in a neonate with severe combined immunodeficiency. J Am Acad Dermatol. 1993;29:862-5.
Ohto H, Anderson KC. Post transfusion graft versus host disease in Japanese newborns. Transfusion. 1996;36:117-23.
Gupta R, ed. Urticaria and Angioedema. Textbook of Dermatology. New Delhi: Jaypees; 2002.
Bruckner AL. Epidermolysis bullosa. In: Eichenfield LF, Frieden IJ, Esterly NB, editors. Neonatal Dermatology. 2nd ed. Philadelphia: Saunders; 2008. p. 159-72.
Johnston GA. Treatment of bullous impetigo and the staphylococcal scalded skin syndrome. Expert Rev Anti-infect Ther. 2004;2:439-46.
Moss RL, Musemeche CA, Kosloske AM. Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg. 1996;31:1142-6.
Hsieh WH, Yang PH, Chao HC, Lai JY. Neonatal necrotizing fasciitis: A report of three cases and review of literature. Pediatrics. 1999;103:53.
Sauerbrei A, Wutzler P. Neonatal varicella. J Perinatol. 2001;21:545-9.
Sterner G, Forsgren M, Enocksson E et al. Varicella-zoster infections in late pregnancy. Scand J Infect Dis. 1990;71:30-5
Prober CG, Gershon AA, Grose C et al. Consensus: varicella zoster infections in pregnancy and the neonatal period. Pediatr Infect Dis J. 1990;9:865-9.
Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev. 2004;17:1-13.
Brown ZA, Wald A, Morrow RA et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. 2003;289:203-9.
Chapman RL. Candida infections in neonate. Curr Opin Pediatr. 2003;15:91-102.
Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous candidiasis: Clinical presentation, pathogenesis, and management guidelines. Pediatrics. 2000;105:438-44.
Ayangco L, Rogers RS. Oral manifestations of erythema multiforme. Dermatol Clin. 2003;21:195-7.
Prendville J. Stevens-Johnsons syndrome and toxic epidermal necrolysis. Adv Dermatol. 2002;18:151-73.
Maguiness S, Guenther L. Kasabach-Merritt syndrome. J Cut Med Surg. 2002;6:335-9.
Rodriguez V, Lee A, Witman PM, Anderson PA. Kasabach Merritt phenomenon: Case series and retrospective review of the mayo clinic experience. J Pediatr Hematol Oncol. 2009;31:522-6.
Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of purpura fulminans. J Environ Pathol Toxicol Oncol. 2008;27:191-6.
Marlar RA, Neumann A. Neonatal purpura fulminans due to homozygous protein C or protein S deficiencies. Semin Thromb Hemost. 1990;60:299-309.
Thapa R, Pramanik S, Dhar S, Kundu R. Neonatal Kawasaki disease with multiple coronary aneurysms and thrombocytopenia. Pediatr Dermatol. 2007;24:662-4.
Zeb A, Darmstadt GL. Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management. J Perinatol. 2008;28:453-60.
Malde B, Ditto AM. Anaphylaxis. Allergy Asthma Proc. 2004;25:52-3.
Tang AW. A practical guide to anaphylaxis. Am Fam Physician. 2003;68:1325-32.
Thong BY, Chan Y. Anaphylaxis during surgical and interventional procedures. Ann Allergy Asthma Immunol. 2004;92:619-28.
Giovannitt J, Bennett CR. Assessment of allergy to local anesthetics. J Am Dent Assoc. 1979;98:701-6.
Briet S, Rueff F, Przybilla B. “Deep impact†contact allergy after subcutaneous injection of local anesthetics. Contact Dermatitis. 2001;45:296-97.
Curley RK, Macfarlane AW, King CM. Contact sensitivity to the amide anesthetics lidocaine, prilocaine, and mepivacaine: case report and review of the literature. Arch Dermatol. 1986;122:924-26.
Chin TM, Fellner MJ. Allergic hypersensitivity to lidocaine hydrochloride. Int J Dermatol. 1980;19:147-48.
Chiu C, Lin T, Hsia S et al. Systemic anaphylaxis following local lidocaine administration during a dental procedure. Ped Emerg Care. 2004;20:178-80.
Schechter JF, Wilkison RD, Carpio JD. Anaphylaxis following the use of bacitracin ointment. Arch Dermatol. 1984;120:909-11.
Phillips TJ, Rogers GS, Kanj LF. Bacitracin anaphylaxis. J Geriatr Dermatol. 1995;3:83-5.
Comaish JS, Cunliffe WJ. Absorption of drugs from various ulcers: a cause of anaphylaxis. Br J Clin Pract. 1967;21:97.
Daughters D, Zackheim H, Maibach H. Urticaria and anaphylactoid reactions after topical application of mechlorethamine. Arch Dermatol. 1973;107:429-30.
Okano M, Nomura M, Hata S et al. Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989;125:50-2.
Pharm NH, Weiner JM, Reisner GS, Baldo BA. Anaphylaxis to chlorhexidine: case report: implication of immunoglobulin E antibodies and identification of an allergenic determinant. Clin Exp Allergy. 2000;30:1001-7.
Martin JB, Ruskin J. Faintness, syncope, and seizures. In: Harrison TR Wilson JD, editors. Harrison’s Principles of Internal Medicine. 12th ed. New York: McGraw-Hill; 1991: p 134-40.
Bircher AJ, Messmer SL, Surber C, Rufli T. Delayed-type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests. Contact Dermatitis. 1996;24:387-9.
Whalen JD. Delayed type hypersensitivity after subcutaneous administration of amide anesthetic. Arch Dermatol. 1996;132:1256-7.
Kaufman JM, Hale EK, Ahinoff RA, Cohen DE. Cutaneous lidocaine allergy confirmed by patch testing. J Drugs Dermatol. 2002;2:192-4.
Amsler E, Flahault A, Mathelier-Fusade P, Aractingi S. Evaluation of re-challenge in patients with suspected lidocaine allergy. Dermatology. 2004;208:109-11.
Emergency Cardiac Care Committee and subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care, IV: special resuscitation situations. JAMA. 1992;268:2242-50.
Delgado-Escueta AV, Wasterlain C, Treiman DM, Porter RJ. Current concepts in neurology: management of status epilepticus. N Engl J Med. 1982;306:1337-40.
Selbst SM. Office management of status epilepticus. Pediatr Emerg Care. 1991;7:106-9.
Furman S. Electrosurgical device interference with implanted pacemakers. JAMA. 1978;239:1910.
Sebben JE. Electrosurgery and cardiac pacemakers. J Am Acad Dermatol. 1983;9:457-63.
Niehaus M, Tebbenjohanns J. Electromagnetic interference in patients with implanted pacemakers or cardioverter- defibrillators. Heart 2001;86:246-48.
LeVasseur JG, Kennard CD, Finly EM, Muse RK. Dermatologic electrosurgery in patients with implantable cardioverter-defibrillators and pacemakers. Dermatol Surg. 1998;24:233-40.
Pinski SL. Emergencies related to implantable cardioverter-defibrillators. Crit Care Med. 2000;28:174-80.
ElGamal HM, Dufresne RG, Saddler K. Electrosurgery, pacemakers and ICDs: a survey of precautions and complications experienced by cutaneous surgeons. Dermatol Surg. 2001;27:385-90.
Levine PA, Baladay GJ, Lazar HL et al. Electrocautery and pacemakers: management of the paced patient subject to electrocautery. Ann Thorac Surg. 1986;41:313-7.
Rao SM, Suhasini T. Organization of intensive care unit and predicting outcome of critical illness. Indian J Anaesth. 2003;47:328-37.