acute and emergency derm Flashcards by Abbie McGuire

consequence of skin not acting as a mechanical barrier?

sepsis

How well did you know this?

Not at all

Perfectly

consequence of skin not regulating temperature?

hypo/hyper - thermia

How well did you know this?

Not at all

Perfectly

consequence of skin not blanking fluid and electrolytes?

protein and fluid loss

renal impairment

peripheral vasodilation

How well did you know this?

Not at all

Perfectly

erythroderma definition?

any inflammatory skin disease affecting >90% of total skin surface

How well did you know this?

Not at all

Perfectly

name 4 causes of erythroderma ?

psoriasis
eczema
drugs
cutaneous lymphoma

How well did you know this?

Not at all

Perfectly

name 5 principles of management of erythroderma?

remove offending drugs

careful fluid balance

good nutrition

T regulation

Emollients - 50:50 liquid paraffin

How well did you know this?

Not at all

Perfectly

describe mild form of drug reaction?

Morbilliform exanthem

How well did you know this?

Not at all

Perfectly

describe severe form of drug reaction?

erythroderma/

Stevens Johnson Sydrome (SJS)/

Toxiz epidermal necrolysis (TEN)/

DRESS

How well did you know this?

Not at all

Perfectly

explain link between SJS and TEN?

thought to form part of the same spectrum

both rare

How well did you know this?

Not at all

Perfectly

which drugs are often a cause of 2y SJS/TEN?

antibiotics
anticonvulsants
allopurinol
NSAIDs

How well did you know this?

Not at all

Perfectly

name 5 clinical features of SJS?

fever
malaise
arthralgia (joint pain)
rash 
mouth ulceration (or any other mucous membrane)

How well did you know this?

Not at all

Perfectly

clinical features of TEN?

prodromal febrile illness

ulceration of mucous membranes

rash

How well did you know this?

Not at all

Perfectly

which sign is often positive in TEN?

Nikolsky’s sign -

cleaving skin where Skin reddens, fluid collects underneath and skin rubs off, leaving raw red base

How well did you know this?

Not at all

Perfectly

2 key things for managing TEN/SJS?

identify and stop culprit drug ASAP

supportive therapy

How well did you know this?

Not at all

Perfectly

name 4 other possible treatments for TEN/SJS?

ciclosporin
IV immunoglobulins
high dose steroids
Anti-TNF therapy

How well did you know this?

Not at all

Perfectly

scoring system for prognosis for TEN/SJS?

SCORTEN

How well did you know this?

Not at all

Perfectly

name 7 possible areas on SCORTEN system?

age >40

malignancy

HR >120

initial epidermal detachment >10%

serum urea >10

serum GLC >14

serum bicarbonate <20

How well did you know this?

Not at all

Perfectly

SCORTEN score = 0-1

mortality risk - 3.2%

How well did you know this?

Not at all

Perfectly

SCORTEN score = 2

mortality risk - 12.1%

How well did you know this?

Not at all

Perfectly

SCORTEN score = 3

mortality risk - 35.3%

How well did you know this?

Not at all

Perfectly

SCORTEN score = 4

mortality risk - 58.3%

How well did you know this?

Not at all

Perfectly

SCORTEN score = 5+

mortality risk - 90%

How well did you know this?

Not at all

Perfectly

what is Erythema Multiforme?

hypersensitivity reaction, usually trigger by HSV or mycplasma pneumonia

onset of Erythema Multiforme?

abrupt - 100s of lesions form within only 24hrs

pattern of spread with Erythema Multiforme?

distal to proximal - | palms and soles are affected first

characteristic presentation of Erythema Multiforme?

evolves over 72hrs, TARGET lesions

treatment of Erythema Multiforme?

it is self-limiting and resolves over 2 weeks - | treat underlying cause

DRESS?

Drug Reaction with Eosinophilia and Systemic Symptoms

presentation of DRESS?

fever widespread rash eosinophilia and deranged liver function lymphadenopathy often other organ involvement

treatment of DRESS?

stop causative drug symptomatic and supportive systemic steroids +/- Immunosuppression or immunoglobulins

clinical features of pemphigus?

flaccid blisters - easily rupture Nikolsky's sign +ve common sites - face axillae groins ill defined erosions in mouth

pathology of pemphigus - what is used?

immunofluorescence | histopathology

clinical features of pemphiGOID?

blisters are tense and intact | intact epidermis forms roof of blister

where are the antibodies directed at on pemphigus v.s. pemphigoid?

pemphigus - at desmosomes pemphigoid - dermo-epidermal junction

5 differences pemphigus v.s. pemphigoid?

pemphigus: ``` uncommon middle aged patients patients are unwell if extensive lesions fragile blisters treat with systemic steroids ``` pemphigoid: ``` common elderly patients extensive lesions, patients still well intact and tense blisters topical steroids as treatment ```

common diagnosis for patients with rapid development of generalised erythema, and a history of psoriasis?

Erythrodermic psoriais and Pustular Psoriasis

common causes of Erythrodermic psoriais and Pustular Psoriasis?

infection | sudden withdrawal of steroids (topical/oral)

2 signs of Erythrodermic psoriais and Pustular Psoriasis?

fever | raised WBC count

Eczema Herpeticum - common group?

children and babies

treatment for Eczema Herpeticum?

dose of Aciclovir | topical steroid to treat eczema if needed

cause of Eczema Herpeticum?

herpes virus, with background of eczema

possible complication of Eczema Herpeticum?

peri-ocular disease - requires ophthalmology

what needs to be considered in adults with Eczema Herpeticum?

underlying immunocompromise

Staphylococcal Scalded Skin Syndrome - groups affected?

commonly - children | also immunocompromised adults

cause of Staphylococcal Scalded Skin Syndrome?

initial staph. infection

presentation of Staphylococcal Scalded Skin Syndrome?

Diffuse erythematous rash with skin tenderness More prominent in flexures Blistering and desquamation follows Fever irritability

treatment of Staphylococcal Scalded Skin Syndrome?

IV antibiotics initially supportive care resolves over 5-7 days with treatment

3 words associated with a type of Urticaria?

weal wheal hive

what is Urticaria?

Central swelling of variable size, surrounded by erythema Dermal oedema

what is the cause of itching/burning caused by Urticaria?

histamine is released into the dermis

what is angiodema urticaria?

a deeper swelling of skin/ mucous membranes

what qualifies as an acute urticaria?

<6 week history

most common cause of acute urticaria?

idiopathic (50%)

other causes of acute urticaria?

viral infection drugs (IgE mediated) food (IgE mediated)

treatment for acute urticaria?

oral antihistamine - taken continuously, up to x4 dose short course of oral steroid if cause of urticaria is clear

what drugs need to be avoided when treating urticaria?

NSAIDs and opiates - these exacerbate urticaria

management of chronic urticaria?

1 - non-sedating H1 antihistamine 2 - higher dose of H1 antihistamine (up to x4 more) 3 - anti-leukotriene OR tranexamic (if angioedema is present) 4 - omalizumab