8. Dermatological Emergencies Flashcards
= The rash is most likely a drug reaction.
= IM adrenaline should be given immediately
= The rash is likely to be the first sign of toxic epidermal necrolysis or Steven-Johnsons syndrome.
= Sending the patient home with a course of oral antibiotics.
= Psoriasis is a common cause of erythroderma.
SJS & TEN
- What are they?
- Aetiology: most commonly implicated drugs? (6)
- Clinical features?
Aetiology - the most commonly implicated drugs are:
1. Co-trimoxazole
2. Lamotrigine
3. Carbamezepine
4. Phenytoin
5. Allopurinol
6. Piroxicam and Meloxicam
SJS & TEN
- Sequelae? (6)
- Management and prognosis?
Sequelae - Patients may experience severe ocular complications, severe pigment alteration, sicca syndrome, hair loss, and mucosal scarring leading to vaginal stenosis, and oesophageal stricture.
Erythema Multiforme
- What is it?
- Aetiology?
- Clinical features?
- Diagnosis?
- Management & Prognosis?
Diagnosis: EM has a very characteristic histopathology. The diagnosis can be confirmed with skin biopsy if necessary.
Management & Prognosis:
- Although major EM can cause significant morbidity, it is not a systemic disease and is not life-threatening.
- The illness lasts about two weeks, and patients survive with supportive care.
What is DRESS?
- 7 Drugs that might cause it?
- 6 Clinical features?
- Management & Prognosis?
Management & Prognosis
- Treatment is with oral prednisolone.
- The condition may last many weeks.
- Mortality is about 10% and usually occurs from hepatitis, colitis, or myocarditis.
What is Uncomplicated Urticaria?
What is Urticaria with Angiodema?
Urticaria
- Aetiology?
- Differential diagnoses?
Differential Diagnoses
- Unlike many other rashes, urticaria is transient and migratory.
- In contrast to urticaria, vasculitis typically appears purpuric and leaves bruises. Urticaria and erythema multiforme can both have targetoid lesions, but erythema multiforme does not migrate.
- The differential diagnosis of angiodema includes erythema nodosum, cellulitis, and drug eruptions; however, these lesions are not migratory.
Management of Urticaria
- Acute? (3)
- Chronic: 5 Investigations? Medication?
What is Anaphylaxis?
Outline the Manageent of Anaphylaxis.
- Adrenaline dose? How often?
Erythroderma
- What is it?
- Aetiology?
- Clinical features?
Erythroderma describes any skin disease that involves 90% or more of the body surface area. Such skin diseases are usually inflammatory, erythematous, and scaly.
Erythroderma
- Approach to erythroderma?
- Management?
Vasculitis
- Introduction: What is it? Tell-tale appearance?
- Aetiology: Adults? Children? Infections?
Vasculitis
- 4 Subgroups?
- Clinical features of Small vessel vasculitis?
Vasculitis can be divided into a number of subgroups. The most important are:
1. Small vessel vasculitis
2. Small & medium sized “mixed” vessel vasculitis
3. Medium sized vessel vasculitis
3. Large vessel vasculitis (usually do not have cutaneous manifestations and not discussed here).
Small vessel vasculitis
- 4 Examples & Their Clinical features?
Small Vessel Vasculitis - Examples:
1. Acute meningococcaemia
2. Acute haemorrhagic oedema
3. IgA mediated vasculitis: Henoch-Schonlein purpura
4. Urticarial vasculitis
Vasculitis
- Clinical features of Medium Vessel Vasculitis: Most common disease?
- Clinical features of Mixed Vessel Vasculitis?
Vasculitis
- Approach to the management: Determine diagnosis & Extent of Involvement?
- Treatment?
Management of Acute Meningococcaemia?
What is Toxic Shock?
- Clinical Features?
- Management?
Management of Toxic Shock
- This condition is an emergency.
- Patients should be admitted to a high dependency area and monitored closely. Many require transfer to ICU.
- Anti-staphylococcal antibiotics should be immediately commenced: IV flucloxacillin, or a cephalosporin for penicillin allergic patients.
- Volume replacement and inotropic support may be required.
- Patients may benefit from IVIG treatment.
Kawasaki Disease
- What is it?
- Clinical Features?
Kawasaki Disease
- It affects children aged 5 years and under.
- It is a multisystem vasculitis with cutaneous, mucosal, and systemic manifestations.
- The most sinister association of this condition is coronary artery lesions in about 20% of cases. If left untreated, this can lead to coronary aneurysm, thrombosis, myocardial infarction, and death.
Management of Kawasaki Disease? (6)
Differentiating Kawasaki Disease and Toxic Shock Syndrome.
- Children under 5?
- Presentation?
- Blood tests
- Supportive features?
- Treatment?
Staphylococcal Scalded Skin Syndrome
- What is it?
- Clinical Features?
- Management?
Management
- If recognised early, oral anti-staphylococcal antibiotics abort the condition.
- Once it is fully expressed, children may be to be admitted to hospital for pain relief and IV antibiotics.
What are Rapidly Growing Haemangiomas of Infancy?
- 8 Indications for Urgent Referral (to dermatologist or paediatrician)?
Patients with Multiple Blisters or Pustules
- Causes?
- 5 Infective Conditions that can cause this?
Allergic Reactions
- Clinical Features?
Management of Severe Contact Dermatitis?
What is Pustular Psoriasis?
- Management?
Management
- Patients require hospital admission and an urgent referral to dermatology.
- They require bed rest, wet dressings, and systemic treatment with cyclosporine or a retinoid.
Immunobullous Diseases
- What are they?
- Clinical Features?
- Management?
What is Pompholyx?
Eczema Herpeticum
- Clinical features?
- Complications?
- Management?
Necrotising Fasciitis
- What is it?
- Clinical features?
- Management?
Skin Biopsy
- Information to the pathologist? (5)
- 7 General principles in selecting a biopsy site?
- Transport media?
Biopsy Site - General principles in selecting a biopsy site:
1. Select a recent lesion.
2. Select a typical lesion.
3. Avoid areas of ulceration and excoriation.
4. If taking a biopsy of an ulcer, take an edge of the ulcer and include normal skin.
5. If taking biopsy of a tumour, take a central part.
6. If taking a biopsy of a vesicular rash, attempt to take a whole vesicle.
7. As a skin biopsy leaves a scar, avoid cosmetically sensitive areas if possible.
Management of Drug Eruption - 4 Steps?
When should you suspect a severe drug reaction?
How will you make the diagnosis?
Severe Drug Reaction
- Management?
- Prevention?
Outline the timing between drugs and reaction for different drugs?
Which drugs cause rashes?
What is the most common type of drug reaction?
- Which drugs?
- Differential diagnosis?
- Onset?
- Prognosis?
- What is the second most common type of drug reaction?
- Are Vasculitic drug reactions common?
- 5 Mechanisms of purpura due to drugs?
Which drugs cause Phototoxic and Photoallergic Drug reactions?
Which drugs cause Pustular Drug Reactions: AGEP?
- Onset?
- Prognosis?
Which drugs cause Fixed Drug Eruptions?
- Onset?
- Differential dianoses?
- Prognosis?
= She is likely to be allergic to amoxicillin. This should be ceased.
= She has urticaria secondary to a viral infection
