Emergencies in dermatology: Diagnosis, classification and therapy

Dermatologic emergencies have been disregarded by the general population and by physicians from other specialties. This article reviews three such potentially life-threatening emergencies from different fields. Spider bites from the genus Loxosceles are relatively painless, thus a dermatologic-emergency diagnosis is rarely based on the identification of the spider. Immunoassays detecting Loxosceles venom are not available. Although most bites are benign, a correct diagnosis is important since, in a minority of patients, severe reactions may ensue. Stevens-Johnson syndrome and toxic epidermal necrolysis are severe rare reactions to drugs. They may result in significant disability or death and, therefore, are clinically important. The optimal treatment remains to be clarified. To date, the best management includes early recognition, prompt withdrawal of causative drugs and supportive care. Necrotizing fasciitis is a life-threatening, rapidly progressing, mostly polymicrobial soft-tissue infection. It primarily involves the superficial fascia. Early diagnosis and appropriate surgical treatment remain a necessary challenge.