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By Azeen Sadeghian, MD
Most rashes we see every day turn out to be easily treatable, but some of them may are indicative of a serious systemic disease.
Clinicians should be on the lookout for any of the following life-threatening rashes:
TSS is an exotoxin-mediated condition related to either Staphylococcal aureus or group A Streptococcal infection. Signs and symptoms of TSS include fever above 102°F (38.9°C), hypotension, diffuse sunburn-like erythroderma (commonly found on palms and soles), and involvement of at least three organ systems. Ocular hyperemia and oral mucosal redness may be features. Delayed desquamation of the hands occurs (development of desquamation may be delayed). Severe cases have noted bullae.
RMSF occurs over a wide distribution throughout the contiguous United States, but cases are most commonly reported from Arkansas, Missouri, North Carolina, Oklahoma, and Tennessee. It can also be seen in northern Mexico and Central and South America. Petechiae and purpura appear first distally on the extremities, including the wrists, ankles, palms, and soles. Without treatment, the case fatality rate is 20%-30%.
These two diseases are actually on a spectrum and vary by body surface area involved. SJS and TEN are typically induced by drugs and result in massive damage to the skin and mucosa. A patient with SJS/TEN has a high fever, skin tenderness, and skin detachment. It is imperative to diagnose this early as management is difficult.
Other rashes to look for that are considered life threatening:
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