acute and emergency dermatology Flashcards
What is a result of the mechanical barrier to infection of the skin failing
sepsis
What does a failure in the thermo-regulation of the skin cause
Hypo or hyperthermia
What does a fluid and electrolyte balance failure of the skin cause
protein and fluid loss
renal impairment
peripheral vasodilation
What is erythroderma
Inflammatory skin disease affecting more than 90% of the total skin surface
What is the management of an erythrodermic patient
Want to keep them warm
Emollients - moisturiser - liquid paraffin
Liquid paraffin
fluid balance
treat infection or cause of erythroderma
manage itch
What warning should be given when giving liquid paraffin
It is very flammable so be careful if the patient is a smoker
What is the common rash seen as a result of drug reaction
morbilliform exanthem - type of macular rash - mild
Severe cases are erythoderma, steven johnson syndrom, toxic epidermal necrolysis , DRESS
What is steven johnson syndrome and toxic epidermal necrolysis
2 conditions of the same spectrum - reactions to drug interactions
What are the common drugs that cause steven johnson syndrome and toxic epidermal necrolysis
antibiotics
anticonvulsants
allopurinol
NSAIDs
How much of the surface of the body is covered in steven johnson syndrome
less than 10%
How much of the body is covered in toxic epidermal necrolysis
More than 30%
What is the presentation of steven johnson syndrome
fever
malaise
arthralgia
maculopapular rash and an erosion covering less than 10% of the body
Mouth ulceration
Ulceration of other mucous membranes including the eyes
What is the presentation of toxic epidermal necrolysis
prodromal febrile illness
ulceration of mucous membranes
start as macular, purpuric or blistering rashes but become confuluent quickly
More than 30% of the body is covered
nikolskys sign could be positive - shaving off skin with finger
What is erythema multiforme
Hypersensitivity reaction triggered by infection which is usually caused by herpes simplex virus - causes abrupt onset of hundreds of lesions on the palms, soles and mucosal surfaces
Itcan also present with target like lesioms
In what order do the lesions appear in erythema multiforme
distal and then proximal
What is the management of erythema multiforme
Self limiting and resolves over 2 weeks
What is DRESS
Drug reaction with eosinophilia and systemic symptoms
What is the presentation of DRESS
Onset 2-8 weeks after drug exposure
fever and widespread rash
eosinophilia and derranged liver function
lymphadenopathy
What is the treatment of DRESS
stop the drug which caused the drug reaction with eosinophilia and systemic symptoms
Start systemic steroids and then weave them off
What is a pemphigus
antibodies targeted at desmosomes which causes flaccid blisters which rupture easily
What is the site of pemphigus
face, axillae and groin
Nikolskys sign may be positive - skin scraped off with the fingers
What is the difference between pemphigus and pemphigoid
PemphiguS - superficial
PemphigoiD - deep
pekmphigus is more severe and they appear unwell while in pemphigopid they appear well
pemphigoid treatment - topical steroids if localised and systemic steroids if diffuse
Pemphigus treatments - systemic steroids and then systemic immunosuppressants
What are the common causes of pustular and erythrodermic psoriasis
infection and sudden withdrawal of oral or topical steroids
How does erythrodermic and pustular psoriasis present
Rapid development of generalised erythema with or without clusters of pustules
Fever and raised WCC
What is eczema herpeticum
disseminated herpes virus infection on a background of poorly controlled eczema
Presents with painful erosions , fever and lethargy
treated with aciclovir
What happens in staphylococcal scaled skin syndrome
Staphylococcus aureus releases an endotoxin which can cause our skin to spilit
causesintra-epidermal blistering which presents as a red scald like rash and then forms large thin blisters which burst and cause the skin to peel
The children appear unwell
Who is staphylococcus scalded skin syndrome most common in
children or in immunocompromised adults
How does staphylococcus scalded skin syndrome present
diffuse erythematous rash with tenderness at the flexures
Fever and irritability
It causes intra-epidermal blistering which presents initially as a tender, red, scald-like rash. This progresses to form large thin blisters which burst leaving the skin to peel - in children and they appear unwell
What is the management of staphylococcal scalded syndrome
IV antibiotics and supportive care
What is urticaria
weal, wheal or hive:
central swelling of variable size around erythema - causes dermal oedema
How does urticaria present
also known as weal, wheal or hive:
central swelling of variable size around erythema - causes dermal oedema
Itching and sometimes burning
angioedema - deeper swelling of the skin or mucous membranes
What is the treatment of acute urticaria (less than 6 weeka)
Oral antihistamine
Short course oral steroid
What are contraindicated in acute urticaria
ACE inhibitors - can cause anioedema
NSAIDS and opiates - exacerbate urticaria
What is the management of chronic urticaria
first line :Standard dose non sedating H1 antihistamine
Second line - higher dose H1 antihistamine
3rd line - consider another agent such as an antileukotrine
4th line 0 immunomodulant such as omalizumab which is a monoclonal antibody to IgE
