Some skin conditions may require intensive care treatment. Early diagnosis can be challenging but is crucial to adequate patient management and decision making, since appropriate treatment influences prognosis. The following skin conditions will be reviewed: severe cutaneous drug reactions (drug reaction with eosinophilia and systemic symptoms [DRESS], Stevens-Johnson syndrome/toxic epidermal necrolysis [SJS/TEN]), acute cutaneous graft versus host disease (aGvHD) following allogeneic stem cell transplantation, infectious diseases (staphylococcal scalded skin syndrome [SSSS], toxic shock-syndrome [TSS], necrotizing fasciitis) and vascular disease (acute infectious purpura fulminans). We focus on the course of the diseases, describing clinical presentation and differential diagnosis as well as diagnostic and therapeutic strategies.