Acute and Emergency Dermatology

Question 1

What is Erythroderma? Causes?

Tevens Johnso Syndrome -> Tozix Epidermal Necrolysis

Answer 1

A symptom more than a sign. Systemically red and swollen (inflammatory) skin (>90%)

Can be due to:
Psoriasis, Eczema, Drugs, Cutaneous Lymphoma, Hereditary disorders, unknown.

Tevens Johnso Syndrome -> Tozix Epidermal Necrolysis
-Part of the same family of drug reaxtions.
-Red patches which end up loosing their epidermal layer..
-Systemically unwell.
-Both due to drug reactions. Usually takes 1-2 weeks after taking the drug to show up (or 72hrs if prev reaction)
-Often includes the lips (grey/white membrane, haemohhragic crusting) and ulceration of other mucous membranes
TJS = erosions under 10% of body, TEN = over 30%

Treatment: Identify and stop drug asap. Supportive therapy, potentially including Highdose steroids/IV Immuniglobulns/Anti-TNF therapy/Ciclosporin

Question 2

SCORTEN

Answer 2

Predictor of morbidity in Tevens Johnso Syndrome -> Tozix Epidermal Necrolysis

5 or more = >90% mortality

Tachycardic >120
Afe >40
Malignancy
>10% epidermal detatchment
Serum Urea >10
Serum Glucose >14
Serum bicarbonate <20

If makes a recovery from acute illness, long term complications aren’t too bad

Question 3

Eryrhema Multiforme due to ?

Answer 3

virus, most commonly HV/Mycoplasmic pneumonia!

Kind of simelar to SJS/TEN, round lesions with a dusky centre - “Target” lesions. Sudden onset of loads, distal to proximal.

Treat underlying cause/if any secondary bact. infections.

Question 4

What is DRESS?

Answer 4

Eosonophillic reaction. Simelar to TEN but no loss of eidermis. 2-8 weeks after drug exposure. Fever and rash.

Question 5

DRESS treatment

Answer 5

Stop causative drug
Symptomatic and supportive
Systemic steroids
+/- Immunosuppression or immunoglobulins

Question 6

WHat causes blistering?

Answer 6

lifting up of the epithelium. Can be due to autoimmune response.

Question 7

Pemphagus vs Pemphagoid

Answer 7

PemphaguS - Split within EpidermiS. Fragile blisters.
Phemphagoid - Epithelium = devOID (split between dermis and epidermis) More common. More in Elderly patients.

Question 8

Erythrodermic psoriasis and Pustular Psoriases

Answer 8

Commonly due to infection/sudden steroid withdrawal

fever, generalised erythema +/- clusters of pustules

Exclude underlying infection, bland emollient, avoid steroids
Often require initiation of systemic therapy

Question 9

Eczema Herpeticum

Answer 9

Disseminated herpes. ACiclovir/treat secondary bact infection.

Question 10

Staphlococcal Scalded SKin Syndrome

Answer 10

Looks like lots of red disc things, esp in flexure areas.. Due to Staph infection - tell by swabbing infected area.

Question 11

Urticaria

Answer 11

Weal/Wheal/Hive, due to histamine release. Often ideopathic. and fleeting.

Question 12

Urticaria vasculitis signs

Answer 12

bruise like things around belly butten alongside wheal/weal.hives

Question 13

Management of Chronic Urticaria?

Answer 13

1. Antihistamine
2. higher dose + second antihistamine
3. Anti-leukotriene/tranexamic acid (if angiodema)
4. Immunomodulant (eg Omalizumab)