Four of the most life-threatening skin conditions and what you should know about them



File 20180312 30965 xaeir3.jpg?ixlib=rb 1.1
Some serious skin conditions are more likely to affect those with weaker immune systems.
from http://www.shutterstock.com

William Cranwell, Melbourne Health

This article is part of our series about skin: why we have it, what it does, and what can go wrong. Read other articles in the series here.


Dermatological emergencies are uncommon, but can cause devastating complications and death if not recognised and treated early. Some skin conditions require treatment in an intensive care unit. Here are some of the most serious skin conditions and what you should know about recognising them.

1. Necrotising fasciitis

Necrotising fasciitis is a severe infection of the skin, the tissue below the skin, and the fascia (fibrous tissue that separates muscles and organs), resulting in tissue death, or necrosis. The infection is rapid, fast-spreading and fatal if not detected and treated early. If not treated with antibiotics and surgery early, toxic shock and organ failure are common.

Necrotising fasciitis may occur in anyone. Previously healthy young people are often affected.

The cause may be one or more bacteria entering the body via an external injury or punctured internal organ. Group A streptococci bacteria, which are the organisms implicated in “strep throat”, are among the most common causes.




Read more:
Explainer: what causes necrotising fasciitis, the flesh-eating bug?


Early necrotising fasciitis is easily missed, as similar symptoms are commonly seen in less severe infection. The initial area is painful, red and swollen. This progresses to a dark, blistered, malodorous and blackened area, which is a sign of tissue death. Other symptoms include fever, intense pain, low blood pressure and shock.

The most important risk factors for necrotising fasciitis include diabetes, peripheral vascular disease, trauma, alcohol and intravenous drug use, and use of non-steroidal anti-inflammatory drugs.

Treatment of necrotising fasciitis is immediate hospitalisation, surgical removal of all dead tissue, and intravenous antibiotics. Patients often require intensive care. Management of shock and other complications reduces the risk of death. Use of a hyperbaric chamber (to increase oxygen delivery to the tissue) and immune therapy may also be required.

Around a quarter of people diagnosed with necrotising fasciitis will die, and sepsis occurs in up to 70% of cases.

Most have heard of necrotising fasciitis as the ‘flesh-eating bug’.
DermNet New Zealand

2. Scalded skin syndrome

Staphylococcal scalded skin syndrome is an uncommon major skin infection. It typically affects newborn babies, young children and adults with reduced immune systems or kidney failure. This syndrome is caused by toxins produced by the bacterium Staphylococcus aureus, which is common in throat, ear and eye infections.

Around 15-40% of adults carry Staphylococcus aureus on the skin surface and have no problems. But these adults may inadvertently introduce the bacteria into nurseries or daycare centres. Because young children have weak immunity to specific toxins, they’re at increased risk of scalded skin syndrome.

Scalded skin syndrome is characterised by a red, blistering rash resembling burns. Early symptoms include fever, skin redness and skin tenderness. Other symptoms may include sore throat or conjunctivitis.

Within 24-48 hours, fluid-filled blisters form on the entire body. The blisters may rupture, leaving areas resembling burns. Large areas of the skin peel off and fall away with only minor touch.




Read more:
Common skin rashes and what to do about them


Scalded skin syndrome requires hospitalisation for intravenous antibiotics and treatment of the wounds. Ruptured blisters require wound dressings, and the skin surface requires intense care to avoid further damage.

Other treatment includes intravenous fluid and electrolyte maintenance to prevent shock and other complications, paracetamol for pain and fever, and avoidance of severe sepsis. Sepsis is when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body, which can be life-threatening.

Complications of scalded skin syndrome include severe infection, pneumonia, cellulitis (a bacterial skin infection) and dehydration. Most children treated appropriately recover well and healing is complete within a week.

Staphylococcal scalded skin syndrome is more likely to occur in people with weaker immune systems – such as children.
DermNet New Zealand

3. DRESS syndrome

Standing for “drug reaction with eosinophilia and systemic symptoms,” DRESS syndrome is a severe reaction that affects the skin and internal organs. The patient may have an extensive rash, fever, enlarged lymph nodes and damage to the liver, kidneys, lungs, heart, blood components or pancreas. Symptoms usually start two to eight weeks after the responsible drug has been taken.

The death rate is estimated between 10 and 20%, most often due to liver failure.

The most common drugs responsible include anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs, antibiotics and sulfa drugs (a type of synthetic antibiotic). The severe reaction is thought to occur due to a pre-existing genetic change in the immune system, a triggering illness (most often a viral infection) and defective breakdown of the drug by the body.

Early diagnosis is essential. The responsible drug must be stopped immediately and patients may require intensive care or burn unit management. More intensive treatment is needed if organs are involved.

DRESS syndrome appears a few weeks after taking a drug the patient is allergic to.
DermNet New Zealand

4. Life-threatening drug reactions

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are variants of a life-threatening reaction that affects the skin and mucous membranes (mouth, eyes, genitals, respiratory or gastrointestinal tracts).

These are unpredictable reactions that leave sufferers critically unwell, with widespread death of the outer skin layer (epidermis), which peels off. The rash generally begins on the trunk and extends to the limbs and face, and there is intense skin pain. Before the rash appears, symptoms include fever, sore throat, runny nose, conjunctivitis and general aches.

It’s almost always caused by medications. The most common medications causing this reaction are anticonvulsants, antibiotics, allopurinol (gout medication), non-steroidal anti-inflammatory drugs and an HIV drug. The reaction usually occurs in the first eight weeks after taking the drug. It’s more likely to happen if the patient has cancer, HIV or specific genes that may play a role.

This reaction can be fatal by causing dehydration and malnutrition, severe infection, respiratory failure, gastrointestinal complications and multi-organ failure.

The responsible drug has to be stopped, and treatment (in a burns unit and intensive care unit) includes wound care, fluid management, pain management and prevention of infection. Long-term complications, including scarring, eye, oral, genital, lung disease and mental health disorders, are common. Around a quarter of people with this reaction will die.


The Conversation


Read more:
The skin is a very important (and our largest) organ: what does it do?


This reaction to medications is totally unpredictable.
DermNet NZ

William Cranwell, Dermatology Clinical Research Fellow, Melbourne Health

This article was originally published on The Conversation. Read the original article.

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Iranian Authorities Release Assyrian Pastor on Bail


Accused of ‘converting Muslims,’ church leader faces trial – and threat of murder.

ISTANBUL, April 5 (CDN) — An Assyrian pastor the Iranian government accused of “converting Muslims” has been released from prison on bail and is awaiting trial.

The Rev. Wilson Issavi, 65, was released from Dastgard prison in Isfahan last week. Conflicting reports indicated Issavi was released sometime between Sunday (March 28) and Tuesday morning (March 30).

On Feb. 2, State Security Investigations (SSI) agents arrested Issavi shortly after he finished a house meeting at a friend’s home in Isfahan. Along with the accusation of “converting Muslims,” the pastor is charged with not co-operating with police, presumably for continuing to hold such house meetings after police sealed the Evangelical Church of Kermanshah and ordered him not to reopen it.

After his arrest, Issavi was held at an unmarked prison facility in Isfahan and apparently tortured, according to a Christian woman who fled Iran and knows Issavi and his family. The Christian woman, who requested anonymity for security reasons, said Issavi’s wife, Medline Nazanin, visited the pastor at the unmarked facility. Nazanin said it was obvious Issavi had been tortured, the Christian told Compass.

Issavi’s confinement cells were so filthy he contracted a life-threatening infection, Nazanin told the Christian woman.

“They took him to the hospital and then returned him back to the prison,” the woman said.

Friends of Issavi added that he is still dealing with the lingering effects of the infection.

During Issavi’s imprisonment, authorities threatened to execute him, sources close to the case said. The joy of Issavi’s family at his release was tinged with fear as they waited in agony for the possibility of him being killed by Islamic extremists, as is common in Iran when Christians are detained for religious reasons and then released.

“Sometimes they release you just to kill you,” the Christian source said.

Issavi has not been informed of his trial date.

Issavi’s friend said that low-key ethnic Christians, such as the Assyrians, are largely unbothered for long periods of time. Active Christians are treated differently.

“When you start evangelizing, then you are in real trouble,” she said.

Iranian authorities have set up a video camera outside Issavi’s church to monitor anyone going in or out of the building, according to the pastor’s friend.

Issavi was one of a few Christians in leadership positions arrested in Isfahan in February during what some Middle Eastern experts described as a crackdown on area church leadership.

Isfahan, a city of more than 1.5 million people located 208 miles (335 kilometers) south of Tehran, has been the site of other anti-Christian persecution. In an incident in July 2008, two Christians died as a result of injuries received from police who were breaking up a house meeting.

On Feb. 28, Isfahan resident Hamid Shafiee and his wife Reyhaneh Aghajary, both converts from Islam and house church leaders, were arrested at their home.

Police handcuffed, beat and pepper-sprayed Aghajary and then took her to prison. Her husband Shafiee, who was away from the house when police arrived, was arrested an hour later when he returned to the house. Approximately 20 police officers raided the home, seizing Bibles, CDs, photographs, computers, telephones, personal items and other literature.

The couple is still being held. Other details about their detainment are unknown.

Three Christians Released

Elsewhere, three Christians arrested on Dec. 24, 2009 have been released, according to Farsi Christian News Network (FCNN).

Maryam Jalili, Mitra Zahmati, and Farzan Matin were initially arrested along with 12 other Christians at a home in Varamin. Eventually they were transferred to Tehran’s notorious Evin Prison, though the other 12 prisoners were conditionally released on Jan. 4. 

Jalili, Zahmati and Matin were freed on March 17, though terms of their release were unclear. Jalili is married and has two children.

Iran has a longstanding history of religious repression. Shia Islam is the official state religion and is ensconced as such in Iran’s constitution. Every year since 1999, the U.S. Secretary of State has designated Iran as a “Country of Particular Concern” for its persecution of Christians and other religious minorities.

According to the 2009 International Religious Freedom Report issued by the U.S. Department of State, persecution of Christians and other religious minorities in Iran continued to get significantly worse.

“Christians, particularly evangelicals, continued to be subject to harassment and close surveillance,” the report states. “The government vigilantly enforced its prohibition on proselytizing by closely monitoring the activities of evangelical Christians, discouraging Muslims from entering church premises, closing churches, and arresting Christian converts.”

Report from Compass Direct News 

VIETNAM: ALLEGED MURDERER OF CHRISTIAN STRIKES AGAIN


Local authorities complicit or turn blind eye to assaults on Christians.

LOS ANGELES, May 11 (Compass Direct News) – A Hmong man in Vietnam’s Northwest Mountainous Region who murdered his mother in February because she had become a Christian has assaulted another Christian, leaving him critically wounded, according to area Christian sources.

Lao Lia Po on April 25 allegedly attacked Koua Lo of Meo Vac district, Ha Giang Province because he had become a Christian, according to a local church leader. Koua sustained severe head injuries; according to witnesses, his head was split open in two places with parts of his brain visible.

Koua was taken to a hospital, but after three days doctors said they could do nothing more for him and sent him home. As his injuries were life-threatening, those close to Koua did not expect him to recover.

The alleged attacker, Lao, is still at large and has not been charged. The assault took place in Sung Can Village, Sung Tra Commune, Meo Vac district, Ha Giang Province.

In the same area two years ago, a 74-year-old woman became the first Christian in the village. Today there are about 100 families who follow Christ, but the cost has been high. Stories of harassment and abuse of Christians in Meo Vac district have circulated for several months, with local Christians saying government officials are either complicit or look the other way.

On Feb. 3, local Christians said, Lao murdered his mother in a similarly brutal fashion, smashing her head until she died. Police only held him overnight before releasing him without charge. The day he was released, local sources said, he again threatened Christians with death.

A Vietnamese pastor petitioned the government to investigate – with no result. Another leader informed U.S. diplomats of the details. Some Vietnamese Christians have complained to Vietnam diplomatic missions abroad, all to no avail.

Advocates of religious freedom in Vietnam say such impunity puts a serious blot on Vietnam’s slowly improving religious liberty record.

Following heavy international scrutiny of Vietnam’s oppression of religion in general and Protestantism in particular, Vietnam promulgated new religion legislation in 2004 and 2005. To date this has led to the legal recognition of six church/denominational organizations, raising the total to eight out of about 70. Additionally, a few hundred of Vietnam’s thousands of house church congregations have been given interim permission to carry on religious activities, and large-scale government campaigns to force ethnic minority Christians to recant their faith have ceased.

High hopes for improvement following the new religion legislation led the U.S. Department of State to take Vietnam off its blacklist of the worst violators of religious freedom in late 2006, which enabled the U.S. government to endorse Vietnam’s accession to the World Trade Organization. And Christian support organization Open Doors this year dropped Vietnam to No. 23 on its World Watch List ranking of religion persecutors. In eight of the last 12 years, Vietnam had been placed among the organization’s top 10 worst religious persecutors.

The U.S. Commission on International Religious Freedom (USCIRF), however, found exceptions to progress so widespread that it again recommended naming Vietnam a Country of Particular Concern (CPC) this year. The recommendation by USCIRF, responsible for monitoring state department compliance with the U.S. 1998 Law on International Religious Freedom, was announced on May 1.

The commission’s report recognizes progress but notes, “There continue to be far too many serious abuses and restrictions of religious freedom in the country. Individuals continue to be imprisoned or detained for reasons related to their religious activity or religious freedom advocacy; police and government officials are not held fully accountable for abuses; independent religious activity remains illegal; and legal protections for government-approved religious organizations are both vague and subject to arbitrary or discriminatory interpretations based on political factors.”

Given the uneven pace of religious freedom progress after removing Vietnam from the list of CPCs, continued detention of prisoners of conscience, and an overall deteriorating human rights situation, USCIRF recommended that Vietnam be re-designated as a CPC.

In Tra Vinh Province in the Mekong Delta Region of southern Vietnam, another Christian was murdered on April 5. Thugs ambushed Thach Thanh No, described as a young and enthusiastic church elder, on his way home from Sunday worship, according to local Christian sources. His family was unable to find him quickly, and he died from his injuries as he was transported to a hospital.

The congregation in Ngoc Bien Commune to which he belonged has long been harassed and threatened by local thugs supported by militant Buddhists, according to area Christians, who emphasized that authorities have done nothing to intervene.

Indeed, in Thach’s case, rather than prosecute the killers, the Ministry of Public Security’s World Security newspaper published an article on April 24 – concocted without any factual basis, according to area Christians – which portrayed him as dying from crashing his motorbike while drunk. His motorbike, however, was found entirely unmarked without any signs of a crash, and his body showed clear signs of a vicious beating, according to area Christians.

“In one case the law winks at the murder of a Christian and does nothing to punish the murderer – in another, authorities actively work to cover up a murder with elaborate lies,” said one long-time advocate for religious freedom in Vietnam. “Such behavior on the part of authorities convinces many Vietnamese Christians that their country’s top officials are still not sincere about improving religious freedom for all.”

Report from Compass Direct News