Desquamating dermatological conditions: The burns surgeon's guide to diagnosis and management

Desquamating or blistering skin conditions may be referred to burns and plastic surgeons owing to the morphological similarity to burn injuries, given an increasing shortage of dermatology inpatient beds within the context of NHS care. Desquamating skin conditions, similar to burn injuries, carry the potential to be severe, debilitating and potentially fatal; however, they present more complexity owing to their underlying aetiologies. These conditions may present with similar physiological challenges, dressing requirements and need for extensive multidisciplinary input as burn injuries, and there is an increasing demand for burns and plastic surgery involvement in their management. In this review, the following blistering skin diseases (BSDs) are discussed: Bullous erythema multiforme, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TENS), pyoderma gangrenosum, impetigo, Staphylococcal scalded skin syndrome, erythroderma, pemphigus vulgaris (PV), bullous lupus, pemphigus paraneoplastica, acute generalised exanthematous pustulosis (AGEP), dermatitis artefacta, linear IgA bullous dermatosis and adverse drug reaction. All patients should undergo a thorough head to toe skin examination, including the mucous membranes, their current and recent medications should be reviewed, and considered for discontinuation if clinically safe. A full panel of blood investigations, including an auto-antibody screen, should be performed to identify the underlying cause and multiorgan disfunction. A single investigation of the greatest diagnostic value is an incision or punch biopsy, which should be sent for histology and immunofluorescence analyses. Antimicrobials and steroids should be initiated by dermatology after review. General care of these patients includes treatment of the underlying cause, management of acute deterioration and symptoms, and appropriate wound care.