Dermatological emergency: recognise the signs and act quickly

What is a dermatological emergency?

A dermatological emergency refers to any skin or mucous membrane condition whose rapid progression and symptoms can lead to serious complications. Dermatological emergencies must therefore be distinguished from non-life-threatening urgent situations that do not require hospitalisation. They require prompt care to prevent hospitalisation, or in some cases death. In practice, this can include:

  •  Extensive bullous lesions and skin detachment (Lyell syndrome, severe pemphigus);

  •  Epidermal necrolysis (Stevens-Johnson syndrome), which can affect the mucous membranes;

  •  Severe skin infections (fasciitis, necrotising cellulitis, dermohypodermitis with systemic symptoms) that may require antibiotic therapy and hospital care;

  •  Erythroderma (diffuse redness over more than 90% of the body's surface), which can lead to metabolic and infectious complications;

  •  Signs of systemic infection (high fever, low blood pressure, rapid heart rate) and manifestations affecting the airways (swelling of the face, throat and pharynx);

  •  And severe drug reactions or any rash, particularly when accompanied by respiratory distress or signs of hypovolaemic shock.

Faced with these red-flag warning signs, the protocol is simple: call the emergency services (SAMU, 15 in France) to assess severity, stop the suspected medication and head straight to hospital care without delay. For other non-life-threatening urgent situations, you can consult a dermatologist urgently via Feeli within less than 24 hours.

What are the warning signs of a dermatological emergency?

Warning signs of dermatological emergencies can notably include (red alert – call the emergency services or go to A&E immediately):

  •  High fever accompanied by a bullous rash and skin detachment (an organ or tissue separating from another).

  •  Significant involvement of the mucous membranes (mouth, eyes, genital and urinary tract).

  •  Respiratory distress or stridor (an abnormal, sharp breathing sound) and rapid swelling (oedema) of the face and airways.

  •  Necrotic wound, suspected necrotising fasciitis, disproportionate pain.

  •  Signs of shock (confusion, low blood pressure, excessively rapid pulse).

These criteria are notably based on the recommendations of the HAS (French National Authority for Health) for severe skin infections and epidermal necrolysis. Hospital referral and urgent discontinuation of the suspected medication are necessary. For amber alerts, it is also necessary to seek urgent care or opt for a teleconsultation via Feeli if there are no signs of life-threatening distress:

  •  Generalised feverish rash with no signs of shock.

  •  Cellulitis or extensive dermohypodermitis but without systemic failure.

  •  A skin lesion that bleeds heavily, or a suspicious nodule progressing rapidly. If you are a patient in Île-de-France, the dermatology emergency access units (Henri Mondor, AP-HP) can handle this type of non-life-threatening consultation in person.

  •  Suspected drug reaction that may require prompt medical advice.

Online consultation complies with HAS standards. It is particularly well suited to triaging patients, providing an initial prescription or follow-up care, but it never replaces hospital care in an emergency. However, it is effective for finding a quick appointment with a dermatologist.

Hospital emergency vs urgent dermatology consultation vs teleconsultation

The choice between calling the emergency services, an in-person dermatology consultation or a teleconsultation depends first and foremost on the severity of the situation. Situations that may be life-threatening and require immediate hospital care notably include:

  •  Fever combined with a bullous rash and skin detachment;

  •  Significant involvement of the mucous membranes;

  •  Respiratory distress;

  •  Signs of shock or necrotising fasciitis.

Regarding an in-person consultation with a dermatologist, it is indicated when a physical examination is required, when samples (biopsy, culture) or procedures are needed, but there is no immediate life-threatening distress. A targeted examination is therefore possible during the consultation, with the option of further tests or starting intravenous treatment or a minor procedure if needed. Finally, teleconsultation via Feeli is a fast and effective option for obtaining an initial diagnosis. Practitioners can issue electronic prescriptions when safety conditions are met, thereby making it easier for patients to access care. Feeli offers care from a dermatologist online within 24 hours and without an appointment.

Dermatological emergencies: where to get care depending on your location?

Here is some useful, non-exhaustive information for finding a dermatologist near you:

  •  Paris – PASS Saint-Louis and Henri Mondor: a dermatology healthcare access unit at Saint-Louis hospital (walk-in reception in the morning). This option is particularly useful for bullous dermatoses and onco-dermatology (skin and mucous membrane cancers).

  •  Lyon – CHU (Croix-Rousse and HCL): the Hospices Civils de Lyon (HCL) provide specialist dermatology consultations (Lyon-Sud, Croix-Rousse, etc.). In-person consultations allow, where necessary, tests, samples and minor procedures to be carried out. In a life-threatening emergency, be sure to call the emergency services (SAMU, 15 in France).

  •  Île-de-France – Hospitals and PASS units (healthcare access units): several centres in Île-de-France offer walk-in units (Henri-Mondor, local sites such as Pontoise, etc.). Check the practical details beforehand.

  •  Dermatologist near me or nearby: enable geolocation on your smartphone and search for the hospitals closest to you.

For a response within less than 24 hours and without needing to travel, teleconsultation via Feeli is an excellent option, particularly if you are looking for a dermatologist who accepts new patients.