Cutaneous Disorders in the Intensive Care Unit

  • Tania M. González Santiago
  • Jacobo M. Orenstein Cardona


Cutaneous disorders in the intensive care unit (ICU) may develop as a consequence of life-threatening diseases or as complications from treatment regimens. Few studies report the prevalence of cutaneous conditions in ICUs. According to current data available, the most common dermatological disorders in this setting are: pathogen-related (35%), peripheral vascular disease-related (27%), and drug reaction-related (21%). The objective of this chapter is to provide a practical pathophysiological and clinical overview of the most common dermatological conditions observed in the ICU. Further research needs to be conducted to study the prevalence, manifestations, and complications of skin disorders in the ICU in a prospective manner, in a larger number of hospitals, and in different geographical locations.


Intensive Care Unit Kawasaki Disease Disseminate Intravascular Coagulation Toxic Epidermal Necrolysis Meningococcal Disease 
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  1. 1.
    Dunnill MG, Handfield-Jones SE, Treacher D. Dermatology in the intensive care unit. Br J Dermatol. 1995;132:226–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Badia M, Trujillano J, Gasco E. Skin lesions in the ICU. Intensive Care Med. 1999;25:1271–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Campos-Fernández M, Ponce-De-León-Rosales S, Archer-Dubon C, Orozco-Topete R. Incidence and risk factors for cutaneous adverse drug reactions in an intensive care unit. Rev Invest Clin. 2005;57:770–4.Google Scholar
  4. 4.
    Fischer M, Fischer M, Soukup J, et al. Key dermatological symptoms in the intensive care unit. Int J Dermatol. 2004;43:780–2.PubMedCrossRefGoogle Scholar
  5. 5.
    Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006;20:485–506.PubMedCrossRefGoogle Scholar
  6. 6.
    Perlroth J, Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007;45:321–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17.PubMedCrossRefGoogle Scholar
  8. 8.
    Habif T. Clinical dermatology. 4th ed. Edinburgh: Mosby; 2003.Google Scholar
  9. 9.
    Vazquez JA. Therapeutic options for the management of oropharyngeal and esophageal candidiasis in HIV/AIDS patients. HIV Clin Trials. 2000;1(1):47–59.PubMedCrossRefGoogle Scholar
  10. 10.
    Lipsett P. Surgical critical care: fungal infections in surgical patients. Crit Care Med. 2006;34:9.CrossRefGoogle Scholar
  11. 11.
    Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004;38:161.PubMedCrossRefGoogle Scholar
  12. 12.
    Stulberg D, Penrod M, Blatny R. Common bacterial skin infections. Am Fam Physician. 2002;66:119–24.PubMedGoogle Scholar
  13. 13.
    Cole C, Gazewood J. Diagnosis and Treatment of Impetigo. Am Fam Physician. 2007;75(6):859–64.PubMedGoogle Scholar
  14. 14.
    Allen C, Patel B, Endom E. Primary bacterial infections of the skin and soft tissues, changes in epidemiology and management. Clin Ped Emerg Med. 2004;5:246–55.CrossRefGoogle Scholar
  15. 15.
    Zetola N, Francis JS, Nuermberger EL, Bishai WR. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. 2005;5:275–86.PubMedCrossRefGoogle Scholar
  16. 16.
    Johnston GA. Treatment of bullous impetigo and the staphylococcal scalded skin syndrome in infants. Expert Rev Anti Infect Ther. 2004;2:439–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41:1373.PubMedCrossRefGoogle Scholar
  18. 18.
    Herf C, Nichols J, Fruh S, et al. Meningococcal disease: recognition, treatment, and prevention. Nurse Pract. 1998; 23:30, 33–6, 39–40.Google Scholar
  19. 19.
    Rajapaksa S, Starr M. Meningococcal sepsis. Aust Fam Physician. 2010;39(5):276–8.PubMedGoogle Scholar
  20. 20.
    Rosenstein N, Perkins B, Stephens D, et al. Meningococcal disease. N Engl J Med. 2001;344:1378–88.PubMedCrossRefGoogle Scholar
  21. 21.
    Hazelzet JA. Diagnosing meningococcemia as a cause of sepsis. Pediatr Crit Care Med. 2005;6(3 Suppl):S50–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Marzouk O, Thomson AP, Sills JA, et al. Features and outcome in meningococcal disease presenting with maculopapular rash. Arch Dis Child. 1991;66:485.PubMedCrossRefGoogle Scholar
  23. 23.
    Ramesh V, Mukherjee A, Chandra M, et al. Clinical, histopathologic & immunologic features of cutaneous lesions in acute meningococcaemia. Indian J Med Res. 1990;91:27.PubMedGoogle Scholar
  24. 24.
    Gardner P. Prevention of meningococcal disease. N Engl J Med. 2006;355:1466.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhody C. Bacterial infections of the skin. Prim Care. 2000;27:459–73.PubMedCrossRefGoogle Scholar
  26. 26.
    Singh TN, Devi KM, Devi KS. Ecthyma gangrenosum: a rare cutaneous manifestation caused by pseudomonas aeruginosa without bacteraemia in a leukaemic patient – a case report. Indian J Med Microbiol. 2005;23:262–3.PubMedGoogle Scholar
  27. 27.
    Vinh D, Embil J. Rapidly progressive soft tissue infections. Lancet Infect Dis. 2005;5:501–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Fast M, Woerner S, Bowman W, et al. Ecthyma gangrenosum. Can Med Assoc J. 1979;120(3):332–4.PubMedGoogle Scholar
  29. 29.
    Vidal F, Mensa J, Almela M, et al. Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes. Arch Intern Med. 1996;156:2121.PubMedCrossRefGoogle Scholar
  30. 30.
    Chan Y, Chong C, Puthucheary J, et al. Ecthyma gangrenosum: a manifestation of Pseudomonas sepsis in three paediatric patients. Singapore Med J. 2006;47:1080–3.PubMedGoogle Scholar
  31. 31.
    Bottone E, Maria R, Janda J, et al. Pseudomonas maltophilia exoenzyme activity as correlate in pathogenesis of ecthyma gangrenosum. J Clin Microbiol. 1996;24:995–7.Google Scholar
  32. 32.
    Greene S, Daniel S, Muller S. Ecthyma gangrenosum: report of clinical, histopathologic, and bacteriologic aspects of eight cases. J Am Acad Dermatol. 1984;11:781.PubMedCrossRefGoogle Scholar
  33. 33.
    Svensson C, Cowen E, Gaspari A. Cutaneous drug reactions. Pharmacol Rev. 2000;53:357–9.Google Scholar
  34. 34.
    Sullivan JR, Shear NH. The drug hypersensitivity syndrome: what is the pathogenesis? Arch Dermatol. 2001;137:357–64.PubMedGoogle Scholar
  35. 35.
    Tas S, Simonart T. Management of drug rash with eosinophilia and systemic symptoms (DRESS Syndrome): an update. Dermatology. 2003;206:353–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Descamps V, Valance A, Edlinger C, et al. Association of human herpes virus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol. 2001;137:301–4.PubMedGoogle Scholar
  37. 37.
    Tennis P, Stem RS. Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study. Neurology. 1997;49:542–6.PubMedGoogle Scholar
  38. 38.
    Burns JC, Glode MO. Kawasaki syndrome. Lancet. 2004;364:533–44.PubMedCrossRefGoogle Scholar
  39. 39.
    Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J. 2002;8:5.PubMedGoogle Scholar
  40. 40.
    Rzany B, Mockenhaupt M, Baur S, et al. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990–1992): structure and results of a population-based registry. J Clin Epidemiol. 1996;49:769–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Harr T, French L. Toxic epidermal necrolysis and Steven-Johnson syndrome. J Rare Dis. 2010;5(39):1–11.Google Scholar
  42. 42.
    Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129:92–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Knowles S, Shear N. Recognition and management of severe cutaneous drug reactions. Dermatol Clin. 2007;25:245–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Choy AC, Yarnold PR, Brown JE, et al. Virus induced erythema multiforme and Stevens-Johnson syndrome. Allergy Proc. 1995;16:157–61.PubMedCrossRefGoogle Scholar
  45. 45.
    Roujeau JC, Huynh TN, Bracq C, et al. Genetic susceptibility to toxic epidermal necrolysis. Arch Dermatol. 1987;123:1171–3.PubMedCrossRefGoogle Scholar
  46. 46.
    Lamoreux M, Sternbach M. Erythema multiforme. Am Fam Physician. 2006;74:1883–8.PubMedGoogle Scholar
  47. 47.
    Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med. 2006;355:1800–10.PubMedCrossRefGoogle Scholar
  48. 48.
    Todd J, Fishaut M, Kapral F, Welch T. Toxic-shock syndrome associated with phage-group-I Staphylococci. Lancet. 1978;2(8100):1116–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Revuz J, Penso D, Roujeau JC, et al. Toxic epidermal necrolysis: clinical findings and prognosis factors in 87 patients. Arch Dermatol. 1987;123:1160–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Kumar V, Abbas A, Fausto N. Robbins and Cotran pathologic basis of disease. 7th ed. Philadelphia, PA: Saunders; 2005.Google Scholar
  51. 51.
    McKenna J, Leiferman K. Dermatologic drug reactions. Immunol Allergy Clin N Am. 2004;24:399–423.CrossRefGoogle Scholar
  52. 52.
    Hynes A, Kafkala C, Daoud Y, Foster C. Controversy in the use of high-dose systemic steroids in the acute care of patients with Stevens-Johnson syndrome. Int Ophthalmol Clin. 2005;45:25–48.PubMedCrossRefGoogle Scholar
  53. 53.
    Calabrese LH, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis. Arthritis Rheum. 1990;33:1108–13.PubMedCrossRefGoogle Scholar
  54. 54.
    Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley’s Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 45.Google Scholar
  55. 55.
    Chung L, Funke AA, Chakravarty EF, et al. Successful use of ­rituximab for cutaneous vasculitis. Arch Dermatol. 2006;142:1407–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Tania M. González Santiago
    • 1
  • Jacobo M. Orenstein Cardona
    • 2
  1. 1.Mayo Clinic Department of Dermatology ResidencyRochesterUSA
  2. 2.Candidate Center for Translational Science ActivitiesMayo Clinic RochesterRochesterUSA

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