Dermatology - Overview
Dermatology is a frequent and diverse part of emergency medicine. Presentations range from self‑limited rashes and eczema flares to life‑threatening conditions such as anaphylaxis, necrotising soft‑tissue infection (NSTI), meningococcal sepsis, and severe cutaneous adverse reactions (SCARs: SJS/TEN, DRESS, AGEP).
A structured, guideline‑informed ED approach improves recognition of red flags, ensures prompt initial treatment, and supports safe disposition and statutory reporting (NICE, Resuscitation Council UK, GOV.UK, RCEM).
Key themes
- Prioritise airway, breathing and circulation first; many dermatology presentations have systemic consequences.
- Use patterns (distribution, morphology, mucosal involvement, pain, systemic features, timing relative to drug exposure) to distinguish diagnoses.
- Document drug exposures and allergies clearly and photograph lesions with consent.
- Be familiar with local antimicrobial policies and national guidance for cellulitis, bites, drug reactions and anaphylaxis (NICE NG141, NG184, CG183; Resuscitation Council UK; GOV.UK).
Common ED presentations (practical grouping)
- Acute systemic reactions: urticaria, angioedema, anaphylaxis.
- Local soft‑tissue infections: cellulitis/erysipelas, abscess, bites, NSTI.
- Vesiculobullous/mucocutaneous syndromes: SJS/TEN, SSSS.
- Severe drug reactions: DRESS, AGEP.
- Febrile exanthems and petechial/purpuric rashes (including meningococcal disease).
- Eczematous/contact dermatitis, scabies, fungal infections, insect bites, vascular/vasculitic lesions.