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Emergencies in
Pediatric Dermatology
Ayelet Shani Adir, M.D.
Pediatric Dermatologist
Haemek Medical Center
Dermatology in Emergency Medicine
• Widespread skin involvement
(massive trans-epidermal loss)
• Skin findings as clues for
diagnosis
Case 1
• 15 months old
healthy infant
• Fever, malaise
and skin
tenderness for
the past 3 days
SSSS
Staphylococcal Scalded Skin Syndrome
• Occurs mainly in infants and young
children (<5 years)
• Malaise, fever, generalized macular
erythema with tenderness of skin
• Exfoliation with exudation and crusting
around mouth, eyes and nose
• Diagnosis- Tzanck smear and bacterial
cultures
SSSS: Clinical Findings
• Generalized erythema with flexural
accentuation
• Skin tenderness
• Flaccid bulla in skin folds
• Positive Nikolsky’s sign
• Desquamation
SSSS: Therapy
• Maintain fluid status
• Intravenous antistaphylococcal antibiotics
• Prevent secondary infection
Case 2
• 11 year old healthy girl
• Generalized skin eruption with
bullae
• Two weeks before: UTI treated with
Resprim for 8 days, later switched
to Zinnat
Physical Examination
• Febrile, 390 C
• Generalized maculo-papular rash
on skin, erosions on oral mucosa
and eyes
• Large tense bulla on skin
Toxic Epidermal Necrolysis
Nikolsky’s
Sign
SJS and TEN
• Incidence: 0.4-1.2 cases per million per
year
• SJS: detachment of <10% BSA with
widespread targetoid lesions
• SJS-TEN overlap: 10-30% detachment
• TEN: >30% detachment
SJS and TEN
• Prodromal period of 1-14 days with
fever, cough, coryza, sore throat,
myalgia
• Extensive erosions of mucous
mebranes: oropharynx, eyes, genitalia,
rectum
• Variable skin involvement
SJS-TEN Therapy
• Prompt discontinuation of suspected drug
• PICU
• Wound care: nonstick dressings,
debridement
• Ophthalmologic intervention
• Hydration, electrolyte balance, nutritional
support, pain control
SJS-TEN Therapy
• Use of systemic corticosteroids is
controversial
• High-dose IVIG (inhibit Fasmediated apoptosis) 0.4-2 gr/kg/d
for 2-5 days
Hypersensitivity Syndrome
Drug Rash with Eosinophila and Systemic
Symptoms (DRESS Syndrome)
• Severe multi-organ reaction
• Fever, rash, Lymphadenopathy and
hepatitis
• Anticonvulsants, sulfa antibiotics
• 1:10000 exposures
Dress Syndrome
• Immediate withdrawal of suspected
drug
• Close monitoring of liver and kidney
functions
• Corticosteroids 1-2 mg/kg
• IVIG
Skin Findings as Clues for
Diagnosis
• Systemic
infections
purpuric, necrotic lesions
of Meningococcemia
• Kawasaki’s
Disease
• Child Abuse
Condyloma
acuminata
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