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Skin and connective tissue disorders 

Skin and connective tissue disorders
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date: 27 November 2020

Although dermatology is generally considered to be an outpatient specialty relating to conditions of low acuity, a wide array of skin problems can present in the critically-ill patient. Some may reflect pre-existing disease, some may occur as a consequence of treatment, and a small fraction will represent severe or extensive primary skin disease that is best managed in a critical care setting. Important primary dermatological conditions that require intensive care management include erythroderma, toxic epidermal necrolysis/Stevens–Johnson syndrome, widespread drug eruptions and blistering disorders with extensive skin involvement. All patients with extensive skin disease will require expert nursing care in order to mitigate the consequences of skin failure. Thus, low-friction beds, non-adherent primary dressings, careful attention to the prevention of infection, temperature regulation, fluid management, and so on are critical. Life-threatening skin disease requires a carefully coordinated multidisciplinary approach involving dermatologists, intensivists, organ specialists, and specialist nurses to improve long-term outcome.

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