It is not always simple to determine whether a skin condition is something that can wait to be seen by your GP, or whether you need immediate medical attention at A&E.
Some skin rashes, infections, or reactions can be serious and, if not treated, can lead to life-threatening complications. Understanding the red-flag symptoms and knowing when to go to A&E can quite literally be a life-saver.
This guide details five serious skin conditions that require immediate emergency medical attention, accompanied by pictures to help you identify them.
What Is It?
Cellulitis is a common bacterial infection of the deeper layers of the skin (the dermis) and the tissue underneath. The bacteria, usually Streptococcus or Staphylococcus, enter the skin through a break, such as a cut, insect bite, or eczema. While it can be treated effectively with antibiotics, it is dangerous if it spreads.
Why It’s an Emergency
If left untreated, cellulitis can rapidly spread to the lymph nodes and into the bloodstream, a condition called sepsis (septicaemia). Sepsis is a life-threatening response to an infection. Cellulitis can also lead to deep-tissue infection, known as necrotising fasciitis (see point 2).
What to Look For (Symptoms):
A large, red, swollen area of skin.
The area is hot and very painful to the touch.
The red area is rapidly growing. It is helpful to trace the edge with a pen to monitor its spread.
Skin that looks tight, glossy, or dimpled (like orange peel).
Red Flag (Go to A&E): You have a very high temperature (fever), you feel generally unwell (like having the flu), you are shivering, or the redness is spreading quickly.
What Is It?
This is a very rare but extremely severe bacterial infection that affects the tissue beneath the skin (the fascia) and the surrounding muscles and organs. It is sometimes called the “flesh-eating disease” because the bacteria release toxins that destroy this tissue. It can be caused by several types of bacteria, often starting from a minor cut.
Why It’s an Emergency
Necrotising fasciitis is a true medical emergency. It spreads incredibly fast and is life-threatening. Early treatment with powerful antibiotics and, usually, surgery to remove the infected tissue is critical to stop its spread and save the patient’s life.
What to Look For (Symptoms):
The symptoms often start quickly, within hours of an injury.
Intense Pain: The most significant early symptom is pain that is much worse than you would expect for the size of the wound or bruise. It might feel like a deep muscle pull.
The area of skin around the wound is red, warm, or swollen.
Flu-like symptoms: fever, stomach ache, and extreme tiredness.
Red Flag (Go to A&E): As the infection spreads, you may develop a very high temperature, the skin may turn dusky, purplish-black, and blistered, or it may feel like it crackles when touched. The area may also become numb. You must seek immediate emergency help if you experience these symptoms, especially after a minor cut or scrape.
What Is It?
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but severe skin reactions, typically caused by a bad reaction to certain medications (such as some antibiotics or epilepsy treatments). TEN is the more severe form of the same condition, affecting a larger area of the body. They cause the top layer of skin (the epidermis) to die and peel off.
Why It’s an Emergency
SJS and TEN are critical and life-threatening conditions. The loss of skin integrity leaves the body extremely vulnerable to infection (sepsis) and leads to severe dehydration and electrolyte imbalances, similar to suffering from extensive burns. Treatment in a specialized burns or intensive care unit is essential.
What to Look For (Symptoms):
SJS/TEN often begins with 1 to 3 days of “flu-like” symptoms, including a cough, body aches, a fever, and sore eyes.
A painful red or purplish rash then appears, often on the face or chest, that spreads over the body.
The rash then turns into blisters.
Red Flag (Go to A&E): Blisters form not only on the skin but also inside the mouth, throat, eyes, and genitals. The top layer of the skin then begins to peel and shed in large sheets. If you have any of these symptoms after starting a new medication, go to A&E immediately.
What Is It?
A severe blood infection that causes caused by meningococcal bacteria that is life-threatening and progresses very rapidly, within hours. There is not always meninigitis at the same time (i.e. causing it).
It may present initially with a “non-blanching rash” is one that does not fade when you press it. While it’s a symptom, not a single disease, it’s a critical sign that a serious medical condition may be present.
When to Go to A&E
If you have a rash that starts as small, pinpoint spots and turns into larger, dark purple, blood-filled blotches (purpura).
What to Look For (Symptoms):
The rash can appear anywhere on the body, including the soles of the feet and the palms of the hands.
It often starts as small red or purple “pinpricks” (petechiae).
It may then spread and become purple or brown “bruise-like” blotches (purpura).
The Glass Test: A critical way to check if a rash is non-blanching is to press a clear drinking glass firmly against it. If you can still see the rash clearly through the glass (it does not fade), it is non-blanching. This is called a glass test.
Red Flag (Go to A&E): If you or someone you are with has a non-blanching rash and is very unwell with other symptoms like a high fever, stiff neck, severe headache, confusion, drowsiness, or sensitivity to light, go to A&E immediately. Do not wait for all the symptoms to appear; a non-blanching rash alone in an unwell person is an emergency.
What Is It?
Anaphylaxis is a severe, life-threatening allergic reaction. It can occur within minutes (or sometimes hours) of being exposed to something you are allergic to, such as a food (like nuts or shellfish), medication (like penicillin), or an insect sting (like a bee or wasp). It involves multiple systems of the body, not just the skin.
Why It’s an Emergency
Anaphylaxis is a true medical emergency. It can cause your airways to narrow, making it very difficult to breathe, and can cause a dangerous drop in blood pressure, leading to shock. Without immediate treatment with an injection of adrenaline (epinephrine), it can be fatal.
What to Look For (Symptoms):
Skin: A sudden itchy rash (hives), flushing, or swelling of the lips, face, or eyes.
Breathing: Trouble breathing, rapid and shallow breaths, wheezing, or a feeling of a lump in your throat.
Other Symptoms: Feeling dizzy or faint (due to a drop in blood pressure), a fast or weak pulse, nausea, vomiting, and diarrhea.
Red Flag (Go to A&E): Any combination of these symptoms following potential exposure to an allergen is a red flag. If there are signs of breathing difficulty or a drop in blood pressure (dizziness, fainting), it is anaphylaxis, and you must call 999 (in the UK) or 911 (in the US) or go to A&E immediately. Use your adrenaline auto-injector if you have one while waiting for help.
What it is: Widespread, intense red skin covering over 90% of the body, often with fever and exfoliation (peeling), or a rapid eruption of white, pus-filled spots (pustular psoriasis). Psoriasis is a cause of erthyroderma.
When to go to A&E: Skin turns rapidly red, feels hot, and starts scaling or peeling, often with fever or chills.
Go to your nearest A&E department immediately if you have a skin problem and experience any of the following:
You feel very unwell: A high temperature (fever), shivering, rapid breathing, or confusion.
The rash is spreading very quickly.
You have blistered and painful skin, especially in your mouth, eyes, or genitals.
The pain is severe and is far worse than you would expect for the appearance of the wound or rash.
A rash that does not fade when you press a glass against it (non-blanching rash).
You are having difficulty breathing or feel like your throat is closing.
Your face, lips, tongue, or eyes are swelling up.
You feel dizzy or faint.
If you are unsure, it is better to be safe and seek immediate medical attention. Remember to tell the medical staff if you have any allergies or have recently started a new medication.
Disclaimer: This article is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. If you are experiencing a medical emergency, you must call 999 (in the UK) or 911 (in the US), or go to your nearest Accident and Emergency (A&E) department immediately.
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