Acute and Emergency Dermatology

Question 1

The skin is a mechanical barrier to infection. What happens regarding this if the skin fails?

Answer 1

Sepsis

Question 2

The skin has a role in temperature regulation. What happens regarding this if the skin fails?

Answer 2

Hypo and hyper thermia

Question 3

The skin has a role in fluid and electrolyte balance. What happens regarding this if the skin fails?

Answer 3

Protein and fluid loss
Renal impairment
Peripheral vasodilation

Question 4

Erythrederma?

Answer 4

Any inflammatory skin disease affecting >90% of the total skin surface

Question 5

List some of the causes of erythroderma.

Answer 5

Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders

Question 6

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis are two conditions which are similar too each other and are secondary to drugs.

Which is more severe?

Answer 6

Toxic Epidermal Necrolysis

Question 7

Which drugs can cause SJS or TENs?

Answer 7

Antibiotics
Anticonvulsants
Allopurinol
NSAIDs

Question 8

When is it SJS or TEN?

Answer 8

SJS when <10% detachment of the epidermis

TEN when 30% or more detachment of the epidermis

SJS-TEN overlap when 10-30%

->regions where the epidermis has died and come off, hence detachment

Question 9

What are the clinical features of SJS?

Answer 9

Fever, malaise, arthralgia
Rash covering <10% of skin
Mouth ulceration
Ulceration of other mucous membrnaes

Question 10

Presentation of TEN?

Answer 10

Prodromal febrile illness
Ulceration of mucous membranes
Rash > 30%, skin starts to come off in sections

Question 11

Management of SJS or TEN?

Answer 11

Identify and stop culprit drug
Supportive therapy as patient usually unwell

Question 12

Which score is used to see what the patient’s prognosis is for SJS or TEN?

Answer 12

SCORTEN

->the higher the score, the higher the risk of mortality

Question 13

What triggers erythema multiforme?

Answer 13

Infection, most commonly Herpes Simplex

Question 14

What happens in erythema multiforme?

Answer 14

Abrupt onset of 100s of lesions over 24hrs, palms an soles being common sites

Question 15

Which investigation is useful in erythema multiforme?

Answer 15

Swab for infection

Question 16

What is the treatment of erythema multiforme?

Answer 16

Self limiting and usually resolves within 2wks
Treat symptoms and underlying cause if required

Question 17

DRESS?

Answer 17

Drug reaction with Eosinophilia and Systemic Symptoms

->just to say, doesn’t look too dramatic, just red rash all over but patient will have systemic symptoms and be unwell

Question 18

What is the treatment of DRESS?

Answer 18

Stop drug causing it
Symptomatic and supportive treatment

Question 19

What is the difference between DRESS drug reaction and SJS/TEN drug reaction?

Answer 19

In DRESS, reaction occurs 2-8wks after drug exposure

In SJS/TEN, drug reaction occurs in first few weeks

Question 20

Which type of drug is usually the cause of DRESS?

Answer 20

Anticonvulsant

Question 21

Pemphigus and pemphigoid are two types of blister.

Which is more common?

Answer 21

Pemphigoid

Question 22

Pemphigus and pemphigoid are two types of blister.

Which has blisters which are more fragile and may not be intact?

Answer 22

Pemphigus

->pemphigoid blisters are usually tense and require popping in order to burst them

Question 23

Which age group tend to be affected more by pemphigus blisters, the more fragile blisters?

Answer 23

Middle aged

Question 24

Which age group tend to be affected more by pemphigoid blisters, the more tough blisters?

Answer 24

Elderly patients

Question 25

Where does pemphigus blisters usually affect?

Answer 25

Mucous membranes Can affect nose, eyes and genital areas

Question 26

Which type of blister is more deep- pemphigoid or pemphigus?

Answer 26

Pemphigoid ->think d for deep in pemphigoiD and s for superficial is pemphiguS

Question 27

Describe pemphigus blisters.

Answer 27

Flaccid blisters which rupture very easily

Question 28

Summarise pemphigus blisters.

Answer 28

Uncommon Middle age Fragile blisters Often affect mucous membranes If extensive, patient systemically unwell

Question 29

Summarise pemphigoid blisters.

Answer 29

Common Elderly Tense and intact blisters Patients usually well systemically even if widespread

Question 30

What is the treatment for pemphigus blisters?

Answer 30

Systemic steroids Dressings for erosions Supportive therapy

Question 31

What is the treatment for pemphigoid blisters?

Answer 31

Topical steroids

Question 32

Psoriasis can occur as Erythrodermic psoriasis or pustular psoriasis, usually in those who have previously had psoriasis or have a strong family history. What are some of the causes?

Answer 32

Infection Sudden withdrawal of oral steroids or potent topical steroid

Question 33

What is seen in patients with erythrodermic psoriasis or pustular psoriasis?

Answer 33

Fever Elevated WCC Pustules- however, sterile pus so if popped, no infection

Question 34

What causes Eczema Herpeticum, a skin emergency, mostly seen in children?

Answer 34

Disseminated Herpes virus infection on a background of poorly controlled eczema

Question 35

What does the skin look like in eczema herpeticum?

Answer 35

Monomorphic blisters with a punch out appearance (basically small, red and round) They are generally painful instead of itchy

Question 36

What is the treatment of Eczema Herpeticum?

Answer 36

Aciclovir Mild topical steroid if required to treat eczema Treat secondary infection

Question 37

If an adult presented with eczema herpeticum, what should you be clinically suspicious of?

Answer 37

Immunocompromise

Question 38

When does staphylococcal scalded skin syndrome usually occur?

Answer 38

In childhood, can occur in immunocompromised adults too

Question 39

What causes staphylococcal scalded skin syndrome?

Answer 39

Initial staph infection

Question 40

Where in the body is staphylococcal scalded skin syndrome most prominent~?

Answer 40

Flexures

Question 41

What is the treatment of staphylococcal scalded skin syndrome?

Answer 41

Admission for IV antibiotics and supportive care

Question 42

Staphylococcal scalded skin syndrome is usually seen in children. If an adult presented similarly, what would you suspect it to be and how could you differentiate?

Answer 42

TEN or drug reaction Biopsy to differentiate

Question 43

What are some other terms for urticaria?

Answer 43

Hives, weals ->like an allergy reaction or nettle rash

Question 44

What does urticaria look like?

Answer 44

Central swelling of variable size surrounded by erythema Dermal oedema is present

Question 45

What are the symptoms of these hives/urticaria?

Answer 45

Itching, sometimes burring ->caused by release of histamine release into dermis

Question 46

How long does urticaria last?

Answer 46

Has a fleeting nature and duration can vary between 1-24hrs

Question 47

How long does urticaria last to be termed acute?

Answer 47

<6wks

Question 48

Causes of acute urticaria?

Answer 48

Half unknown Infection, usually viral Drugs or allergy - IgE mediated Food- IgE mediated

Question 49

What is the treatment for acute urticaria?

Answer 49

Oral antihistamine Sometimes short course of oral steroids

Question 50

Which drugs should be avoided in those with urticaria?

Answer 50

Opiates NSAIDs ->both exacerbate urticaria

Question 51

What is the most common cause of chronic urticaria ~(>6 wks)

Answer 51

Autoimmune

Question 52

What is used in the management of chronic urticaria?

Answer 52

Tranexamic acid Montelukast Immunosuppression

Question 53

OKAYYYY END OF THIS BLOCK

Answer 53

Watch the QnA at the end of this block and try and answer all the questions for revision xx

Question 54

OKAYYYY END OF THIS BLOCK

Answer 54

Watch the QnA at the end of this block and try and answer all the questions for revision xx