I had a patient in my care yesterday who was a pretty interesting case. I had never seen anything like it (I am relatively new to nursing...still in new grad orientation). This patient had a history of skin cancer, lung cancer, and was admitted for pneumonia. The major issue all day, however, became skin care. This woman had SEVERE flaking of the skin from HEAD TO TOE. It was so terrible that the some areas were becoming raw, red, and bleeding, especially on her back. The physicians were more concerned about the pulmonary issues and sepsis (MRSA in blood) than the skin. Now, I know that dehydration can cause dry, itchy, flaky skin, but I never thought this bad. I considered dehydration to be the problem due to the following reasons: 1. patient sucked down fluids like I had never seen 2. patient stated she had had no oral intake for the previous 4 DAYS 3. patient took in 1350 cc in 8 hours and only put out 100cc very concentrated urine.
I guess my question is, has anyone ever see dehydration cause skin dryness, flaking, and itching this severe? Unfortunately, the patient was transferred to Johns Hopkins, where she had been previosuly followed, before the skin condition was addressed. I mean, this poor lady was screaming in agony, fear, and pain . Anyone seen anything like this, and if so, was it due to dehydration or is it a specific condition?
Although skin is the largest organ we have and skin failure is a very real and critical problem, what concerns me is that you stated that you felt that it was THE problem. It appears to me that airway was being addressed first, then the infection. The low UOP is probably due to the sepsis and need for increased volume secondary to sepsis. If they are febrile they probably dehydrated which may not be helping their skin issues. BUT airway and source and treatment of infection would most important. Unless, you had a large stage 3 or 4 ulcer which could be the cause of the sepsis. I have often seen flaking skin in very critical African Americans. Especially those with renal issues. No amount of lotion or type that our wound care group put on it helped it. We just had to be meticulous about keeping skin folds dry and turning and keeping sheets and draw sheets smooth.
my first guess was sjs as well. The one pt ive seen with it didn't look like the pics either but you literally had to wade through dead skin on the floor.
we have a gal with Norwegian scabies and she intially sounded like this gal-but if you've seen SJS you'll never forget it---it really is nothing like any other dermatological condition.....
Norwegian scabies???
Never heard of that before, and it struck me funny. Had a visualization of little nordic mites scurrying around going "Jooorda hoornga ja sure ja betcha hinga flurvelessen..."
Was this a new onset condition? If not, did you ask the patient how long it had been going on? Psoriasis and eczema could both the culprit if this was a chronic problem for the patient. Normally psoriasis affects the extremities or patches of skin, but it could be all over too. That was my first though. Scabies is possible as well.
I agree it sounds like Stevens Johnson syndrome or other skin infection. I had a patient once that had so much skin flaking that you could see a trail of it outside the door to his room in the carpet (that we were tracking out on our shoes). I had to call housekeeping to vacuum it up!
That remind me of a similar incident my grandmother went through. She flaked every available cell of skin off her body. The cause: She had used an insecticide bomb and didn't vacate the house while it was going off. It was incredibly dramatic looking to see her shed so much skin.
When I was in clinicals we has a lady that her skin was peeling so badly that they could not even keep the floor clean. Turns out that it was an allergic reaction to a med she was being given.
I was going to say scabies, SJS, or staph, esp if she has it in her blood. Scabies...just makes me want to itch! There are also certain types of ichthyosis that people can have. They just shed skin like mad.
. Anyone seen anything like this, and if so, was it due to dehydration or is it a specific condition?
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Barb100
1 Post
Luvbug could u send me ur email. [email protected]. My son is suffering from the skin condition u wrote about. I'm desperate. Thank you. barbara