Acute skin failure (ASF) occurs following dermatological conditions that cause total skin dysfunction. Normal skin withstands mechanical damage, protects the body from external contaminants, controls heat loss from the body, and keeps body fluids and protein, all of which gets failed in ASF. 

Its treatment demands a multidisciplinary approach that aims to arrest the progression and heal the already formed lesions, wound care, fluid, electrolyte, and diet management. Along with medical management, it is important to equally consider supportive therapy with the correction of fluid and nutrient losses. 

The primary care in acute skin failure involves maintaining airway breathing and circulation; Securing the IV line and checking for vitals; sending blood for investigations; shifting the patient to the dermatological ICU; maintaining environmental temperature and humidity; identifying any signs of sepsis and initiating antibiotics if present; inserting a nasogastric tube and catheterizing if necessary; seeking interdepartmental consultations for systemic involvement; using prognostic scoring like SCORTEN; documenting everything; calculating area involved, fluid body weight, and nutritional requirement; and barrier nursing.

Specific therapy comprises identifying the cause of ASF, starting specific treatment, and wound care.

Furthermore, monitoring pulse rate, blood pressure and parameters, intake and output, body weight, signs of sepsis, disease progression, systemic involvement, and side effects secondary to treatment are also crucial.

Lastly, it must be remembered that fluid and diet correction should be optimum, neither underdone, which can delay recovery, nor overdone, which can cause complications. 

George NM, Potlapati A, Shivanna R. Fluid and diet management in acute skin failure. Clin Dermatol Rev 2022;6:1-5