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FOCUSED SHIFT VIEW

Rash, Purpura & Dermatologic Emergencies

Rash is skin until it is sepsis, necrosis, mucosal disease, or anaphylaxis.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Assess illness severity, vital signs, mucosa, eyes, palms/soles, and whether lesions blanch.
  2. Separate infectious/toxic, medication-related, ischemic/necrotizing, and allergic patterns.
  3. Photograph or mark progression when appropriate; reassess rather than trusting a single examination.

2 · Escalate now if

  • Nonblanching purpura with fever or shock
  • Painful, rapidly spreading, anesthetic, bullous, or necrotic skin
  • Mucosal or ocular involvement
  • Facial/tongue swelling, wheeze, hypotension
  • New high-risk medication with skin pain or blistering

3 · Immediate workup

  • Sepsis workup and broad treatment when toxic or purpuric
  • Surgical consultation first when necrotizing infection is plausible

4 · Don’t miss

  • Meningococcemia / purpura fulminans
    Toxic patient with nonblanching petechiae or purpura: resuscitate, cultures/antibiotics per sepsis protocol, and escalate.
  • Necrotizing soft-tissue infection
    Pain out of proportion, rapid progression, bullae, anesthesia, or systemic toxicity; urgent surgical review.
  • SJS/TEN or severe drug reaction
    Mucosal erosions, targetoid/blistering rash, skin pain, or detachment after a medication exposure.
  • Anaphylaxis / angioedema
    Skin findings plus airway, breathing, circulation, or severe GI involvement is anaphylaxis.

5 · Disposition lane

Admit / specialty review

Extensive cellulitis, immunocompromise, diagnostic uncertainty, mucosal disease, or failed outpatient treatment.

Resuscitation / OR / burn-level care

Sepsis/purpura, necrotizing infection, anaphylaxis, or extensive SJS/TEN.