Acute And Emergency Dermatology Flashcards
1
Q
List the typical types of skin drug reactions
A
- maculopapular
- urticaria
- morbilliform (like measles)
- papulosquamous (raised areas with flakes)
- photo-toxic (can have T-shirt pattern)
2
Q
List the more rare skin drug reactions
A
- pustular
- lichenoid (purple discolourisation with white lacey network on top)
- fixed drug rash
- bullous (blistering)
- itch (no rash)
3
Q
What are the common drugs which can cause drug rashes?
A
- antibiotics eg. Penicillin
- NSAIDs
- chemotherapeutic agents
- psychotropic eg. Chlopromazine
- anti-epileptics eg. Lamotrigine
- cardiac drugs eg. ACEi, BB, anticoagulants
4
Q
What is vasculitis?
A
- acute reaction in the skin, leaking of blood vessels into the skin
- can be triggered by: infection, drugs, connective tissue disease eg. RA
- important to check for systemic vasculitis
5
Q
What characterises a drug-induced psoriasiform rash?
A
- well-demarcated, salmon coloured plaque with hyperkeratosis
- sudden onset with no family history
- caused by drugs such as lithium, beta-blockers
6
Q
Describe the features of Steven Johnson Syndrome
A
- drug/infection induced
- ulceration around the mouth and mucosal surfaces
- <10% skin involvement (if + then TENS)
7
Q
Describe toxic epidermal necrolysis
A
- severest form of blistering (associated with SJS) which causes splitting of the skin and full thickness shearing of the epidermis
- dermatological emergency
- majority of cases are drug induced
8
Q
Describe the management of toxic epidermal necrolysis
A
- stop drug which is suspected to be cause
- emergency requiring in-patient management
- analgesia, fluid balance, SCORTEN severity scale (calculates mortality)
- infection control/prophylaxis
- urology, gynae, ophthalmology input to check other mucosal surfaces
9
Q
Describe staphylococcal scalded skin syndrome
A
- not to be mistaken for TENS
- widespread light peeling of the skin
- treatment = clear staph infection with antibiotics
10
Q
Describe the features of erythema multiforme
A
- self-limiting allergic reaction
- annular or circular lesions with red, pale, red ring with the central red ring having blistering
- EBV, HSV and occasionally drug caused
- no to mild disease
- commonly on palms of hands
11
Q
Describe bullous pemphigoid
A
- immune reaction occuring at the bottom of the epidermis, resulting in splitting of the epidermis from the dermis in a blistering fashion
- can occur in oral cavity and conjunctivae (as well as outer sites)
12
Q
Describe pemphigus vulgaris
A
- superficial immune reaction affecting just the dermis, some blistering but not intact as the epidermis is thin so results in shearing of the skin in raw erosions
- can affect sites of trauma
13
Q
Describe dermatitis herpetiformis
A
Tiny vesicle blisters, symmetrical distribution on extensor surfaces of buttocks and knees
14
Q
How would you investigate an immunobullous disorder?
A
Skin biopsy with immunofluorescence
15
Q
Describe the treatment of immunobullous disorders
A
- reduce autoimmune reaction with topical/oral corticosteroids
- steroid sparing agents such as azathioprine, anti-inflammatory tetracyclines
- burst any blisters
- dressing and infection control
- check for oral/mucosal involvement
- screen for underlying malignancy (if paraneoplastic phenomenon)
