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Dermatology > Acute and Emergency Dermatology > Flashcards

Acute and Emergency Dermatology Flashcards

1
Q

What are the normal functions of the skin and consequences of failure?

A

Mechanical barrier to infection - sepsis
Temperature regulation - hypo or hyperthermia
Fluid and electrolyte balance - protein + fluid loss, renal impairment and peripheral vasodilation

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2
Q

What is erythroderma?

A

A descriptive term rather than diagnosis
Any inflammatory skin disease affecting more than 90% of total skin surface

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3
Q

What are the causes of erythroderma?

A

Psoriasis, eczema, drugs, cutaneous lymphoma, hereditary disorders and unknown

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4
Q

What are the principles of management for erythroderma?

A

Remove any offending drugs, careful fluid balance, good nutrition, temp. regulation, emollients, oral and eye care, anticipate and treat infection, manage itch and disease specific therapy

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5
Q

What is a type of mild drug reactions affecting the skin?

A

Morbilliform exanthem

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6
Q

What are some types of severe drug reaction affecting the skin?

A

Erythroderma, Stevens Johnson Syndrome/ Toxic epidermal necrolysis and DRESS

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7
Q

Describe Stevens Johnson syndrome/ toxic epidermal necrolysis

A

2 conditions which are part of the same spectrum - TEN is more severe with more than 30% of skin affected
Rare
Secondary to drugs
Can be delayed onset

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8
Q

What drugs can Stevens Johnson Syndrome/ Toxic Epidermal Necrolysis be secondary to?

A

Antibiotics, anticonvulsants, allopurinol and NSAIDs

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9
Q

What is the surface of epidermal detachment in SJS and TEN?

A

SJS - Under 10% epidermal detachment
SJS-TEN overlap - 10-30%
TEN - over 30%

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10
Q

What are the clinical features of SJS?

A

Fever, malaise, arthralgia, rash ( macropapular, target lesions and blisters), mouth ulceration and ulceration of other mucous membranes

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11
Q

Describe toxic epidermal necrolysis presentation

A

Often presents with prodromal febrile illness
Ulceration of mucous membranes
Rash - may start as macular, purpuric or blistering, rapidly becomes confluent and sloughing off large areas of epidermis

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12
Q

What is the management for SJS and TEN?

A

Identify and stop culprit drug as soon as possible
Supportive therapy

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13
Q

How is prognosis of SJS/ TEN calculated?

A

SCORTEN score
Age >40, malignancy, heart rate >120, initial epidermal detachment >10%, serum urea >10, serum glucose >14 and serum bicarbonate <20

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14
Q

What are the long term complications of SJS or TEN?

A

Pigmentary skin changes, scarring, eye disease + blindness, nail + hair loss and joint contractures

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15
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infection - most commonly HSV then mycoplasma pneumonia
Abrupt onset up to 100s of lesions on body over 24hrs
Self limiting and resolves in 2 weeks
Symptomatic and treat underlying cause

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16
Q

What is the presentation of erythema multiforme?

A

Distal to proximal
Palms and soles
Mucosal membranes
Evolves over 72hrs - pink macules and my blister in centre

17
Q

What does DRESS stand for?

A

Drug reaction with eosinophilia and systemic symptoms

18
Q

Describe DRESS

A

Mortality up to 10%
Onset between 2-8 weeks after drug exposure
Fever and widespread rash
Eosinophilia and deranged liver function
Lymphadenopathy and other organ involvement

19
Q

What is the treatment for DRESS?

A

Stop causative drug
Symptomatic and supportive
Systemic steroids
Maybe immunosuppression or immunoglobulins

20
Q

What are the clinical features of pemphigus?

A

Antibodies targeted at desmosomes
Skin - flaccid blisters and rupture very easily
Common sites - face, axillae and groins
Nikolsky’s sign may be +

21
Q

Where else can pemphigus also affect?

A

Commonly affects mucous membranes
Ill defined erosions in mouth
Can also affect eyes, nose and genital areas

22
Q

How is pemphigus and pemphigoid diagnosed?

A

Immunofluorescence skin biopsy is gold standard

23
Q

Describe pemphigoid

A

Antibodies directed at dermo-epidermal junction
Intact epidermis forms roof of blisters
Blisters are usually tense and intact

24
Q

What are the main characteristics of pemphigus?

A

Uncommon, middle age, blisters are fragile, mucous membranes usually affected, may be unwell if extensive and treat with systemic steroids + dress erosions

25
Q

What are the main characteristics of pemphigoid?

A

Common, elderly patients, bisters often intact + tense, patients fairly well systemically and topical steroids may be sufficient if localised

26
Q

What are the common causes of erythrodermic psoriasis and pustular psoriasis?

A

Infection and sudden withdrawal of oral steroids or potent topical steroids

27
Q

What is erythrodermic psoriasis and pustular psoriasis?

A

Rapid development of generalised erythema and maybe cluster of pustules
Fever and elevated WCC
Exclude underlying infection, bland emollient and avoid steroids
Often need systemic therapy

28
Q

Describe eczema herpeticum

A

Disseminated HSV on background of uncontrolled eczema
Monomorphic blisters and punched out erosions
Generally painful and not itchy
Fever and lethargy

29
Q

What is the treatment for eczema herpeticum

A

Treatment dose acyclovir
Treat secondary infection
Mild topical steroid if needed to treat eczema
Possible ophthalmology input
In adults consider underlying immunocompromise

30
Q

Describe staphylococcal scalded skin syndrome

A

Common in children and immunocompromised adults
Initial staph infection
Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation follows
Fever and irritability

31
Q

What is the treatment for staphylococcal scalded skin syndrome?

A

Admission for IV antibiotics initially and supportive care
Generally resolves over 5-7 days with treatment

32
Q

What is the pathophysiology of staphylococcal scalded skin syndrome?

A

Staphylococcus produces toxin which targets desmoglein 1

33
Q

How does urticaria present?

A

Weal, wheal or hive - central swelling surrounded by erythema and dermal oedema. Itching and sometimes burning. duration 1-24hrs
Angioedema - deeper swelling of the skin or mucous membranes

34
Q

What are the causes of acute urticaria?

A

Idiopathic
Infection - viral usually
Drugs - IgE mediated
Food - IgE mediated

35
Q

What is the treatment of acute urticaria?

A

Less than 6 week history
Oral antihistamine
Short course oral steroid may be a benefit
Avoid opiates and NSAIDs if possible

36
Q

What are the causes of chronic urticaria?

A

More than 6 week history
Autoimmune/ Idiopathic
Physical
Vasculitis
Rarely type 1 hypersensitivity reaction

37
Q

What is the management for chronic urticaria?

A

Standard dose non-sedating H1 antihistamine
Then move up to higher dose and add in second antihistamine
Consider second line agent - anti-leukotriene and tranexamic acid
Consider immunomodulant - omalizumab

Dermatology (10 decks)

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