Serious skin signs in sick patients


In emergency medicine and critical care it is essential to be able to recognise skin signs that signify serious disease, and be able to consider the likely causes.

Signs and causes

Generalized red rash with fever

  • Viral exanthems
  • Rickettsial exanthems
  • Drug eruptions
  • Bacterial infections with toxin production

Generalized red rash with blisters and prominent mouth lesions

Generalized red rash with pustules

  • Pustular psoriasis (von Zumbusch)
  • Drug eruptions

Generalized rash with vesicles

  • Disseminated herpes simplex
  • Generalized herpes zoster
  • Varicella
  • Drug eruptions

Generalized red rash with scaling over whole body

  • Exfoliative erythroderma

Generalized wheals and soft tissue swelling

  • Urticaria and angioedema

Generalized purpura

Generalized purpura that can be palpated

  • Vasculitis
  • Bacterial endocarditis

Multiple skin infarcts

  • Meningococcemia
  • Gonococcemia
  • Disseminated intravascular coagulopathy

Localized skin infarcts

  • Calciphylaxis
  • Atherosclerosis obliterans
  • Atheroembolization
  • Warfarin necrosis
  • Antiphospholipid antibody syndrome

Facial inflammatory edema with fever

  • Erysipelas
  • Lupus erythematosus

References and Links

  • Wolff K, Johnson RA. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Fifth Edition, McGraw Hill, 2009.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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