Severe acute allergic reactions include urticaria, angioedema, anaphylaxis, Steven Johnson Syndrome, toxic epidermal necrolysis, life threatening stings and bites. Life threatening infections include necrotizing soft tissue infections, fungal and viral infections with complications. Severe dermatological conditions include: autoimmune vesiculobullous disorders, collagen vascular disorders, unstable psoriasis, cutaneous involvement in paraneoplastic disorders and systemic infections.

Treatment

Dermatological emergencies can only be managed at tertiary care centre.

Non-pharmacological treatment

•        Treat the primary cause.

•        Maintain CAB (circulation, airway and breathing).

•        Careful monitoring of the vitals.

•        Fluid and electrolyte management.

•        Intake and output chart.

Pharmacological treatment (only at tertiary centres)

•        Systemic corticosteroids for autoimmune blistering and collagen vascular disorders (dose depending on the severity of involvement and taper according to the response on follow up).

•        Appropriate antibiotics like Tab. Azithromycin 500 mg OD for 3/5days, Tab. Erythromycin 500 mg QID for 5/7 days.

•        Antiviral like Tab. Acyclovir 400 mg TDS for 7 days.

•        Antifungals like Tab. Fluconazole 50-100 mg/day for 7-10 days (depending on severity).

•        Immunosuppressant drugs used with caution and monitoring like cyclophosphamide 1- 1.5mg/kg/day, azathioprine 1-2mg/kg/day, cyclosporine (2mg/kg/day).

•        IV Immunoglobulin and biological agents (rarely used).