When a Rash or Skin Problem Is an Emergency

Call 911 for a rash that does not fade when you press on it, especially with
fever, headache, a stiff neck, vomiting, drowsiness or light hurting the eyes.

Press a clear glass against it. If the marks stay visible through the glass
rather than going pale, that is a rash of bleeding under the skin, and with
those symptoms it is an emergency.

And the crucial second half, which most versions of this advice leave out: a
rash that does fade is not a reason to relax. That test rules something
in, never out — the rash can appear late, or not at all. If someone is
seriously unwell, the rash is not the deciding factor.

Most skin problems are not emergencies. This page is about the ones that are.

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Come in now, or call 911

• A rash that does not fade under pressure — see above
• Pain that is far worse than the skin looks, in an area that is spreading,
  swollen, or has changed colour, especially with fever. Pain out of
  proportion to the appearance is the warning sign, and it can develop
  quickly.
• Blistering or peeling skin, particularly with sores in the mouth, eyes or
  genitals — and above all if a new medication was started in the past few
  weeks. Stop nothing on your own; come in and bring the medication.
• Swelling of the face, lips or tongue, or any rash with breathing
  difficulty — that is an allergic emergency
• Spreading redness with fever, or red streaks running from a wound
  toward the body
• Shingles on the face, and particularly near the eye or on the tip of the
  nose. The eye is at risk and treatment is time-sensitive.
• Any sudden widespread rash in someone who feels very unwell
• A wound that is hot, tight and increasingly painful after a day or two
• Any skin infection if you have diabetes, are on chemotherapy or steroids, or
  have a weakened immune system. The threshold is genuinely lower and the
  usual signs may be muted.

Same-day, but not a 911 call

• Cellulitis — a warm, red, tender, spreading area, often on a leg, with or
  without fever
• Shingles anywhere else, where antiviral treatment works best started early
• A wound that will not stop bleeding, or one that may need closing
• An animal or human bite, which infects more readily than it looks like it
  should
• A burn — see burns
• A diabetic foot sore, however small

The skin problems that usually settle

Most eczema and psoriasis flares, contact reactions to a new detergent or plant,
heat rash, mild hives without any breathing symptoms, acne, athlete's foot,
insect bites that are itchy but settling, and dry skin — which in this climate is
practically universal.

These change character quickly, though, and that is the part to watch: a
fever appearing, an area spreading fast, or pain that outruns how the skin
looks. Any of those and it is a different problem from the one you started with.

If the skin is worrying you now, come in. Rashes are hard to judge from the
outside and harder to judge on yourself at night — we are open every hour, and
being told it is settling is a perfectly good reason to have come.

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Three things the skin says about the rest of you

The old title asked what your skin is telling you. Mostly it is telling you
about your skin — but occasionally it is reporting on something else, and these
are the three worth knowing:

Yellowing of the skin or the whites of the eyes — the liver. Be seen,
particularly with abdominal pain, pale stools or dark urine.

New, severe, widespread itching with no rash to explain it — worth
investigating rather than treating with moisturiser, especially if it is
persistent or wakes you.

Sudden bruising, or small red-purple dots in clusters, without an injury to
account for it. That is bleeding under the skin and it is the same sign as the
non-fading rash above, in a quieter form.

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Arizona skin, briefly

• Sun damage is cumulative and this is one of the sunniest places in the
  country. A changing mole or a sore that will not heal is a
  dermatologist matter rather than an emergency one — but it is worth
  acting on rather than watching for a year.
• Dry air makes skin crack, and cracked skin is an entry point for
  infection. Relevant mainly if you have diabetes or poor circulation.
• Scorpion stings, rattlesnake bites
  and heat rash have
  their own pages.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• Laboratory work on site, which is often how a serious skin infection is
  distinguished from an ordinary one.
• Imaging on site where an infection may have gone deeper than the skin.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours — useful in this presentation because
  a spreading infection is assessed partly by whether it has spread since
  you arrived. Marking the edge and looking again hours later is genuinely
  informative.

If admission, intravenous treatment beyond what we provide, surgery, or
specialist care is needed, we stabilise and arrange the transfer. We are an
emergency room, not a hospital.

What helps us most: when it started, whether it has spread and how fast,
any new medication in the last few weeks, your temperature if you have taken it,
and a photo from earlier if you have one. A photo from yesterday is
surprisingly useful — rate of change is the thing we most want and cannot see
from a single look.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Skin Conditions — https://medlineplus.gov/skinconditions.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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