acute and emergency dermatology Flashcards

1
Q

What is a result of the mechanical barrier to infection of the skin failing

A

sepsis

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2
Q

What does a failure in the thermo-regulation of the skin cause

A

Hypo or hyperthermia

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3
Q

What does a fluid and electrolyte balance failure of the skin cause

A

protein and fluid loss
renal impairment
peripheral vasodilation

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4
Q

What is erythroderma

A

Inflammatory skin disease affecting more than 90% of the total skin surface

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5
Q

What is the management of an erythrodermic patient

A

Want to keep them warm

Emollients - moisturiser - liquid paraffin

Liquid paraffin

fluid balance

treat infection or cause of erythroderma

manage itch

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6
Q

What warning should be given when giving liquid paraffin

A

It is very flammable so be careful if the patient is a smoker

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7
Q

What is the common rash seen as a result of drug reaction

A

morbilliform exanthem - type of macular rash - mild

Severe cases are erythoderma, steven johnson syndrom, toxic epidermal necrolysis , DRESS

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8
Q

What is steven johnson syndrome and toxic epidermal necrolysis

A

2 conditions of the same spectrum - reactions to drug interactions

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9
Q

What are the common drugs that cause steven johnson syndrome and toxic epidermal necrolysis

A

antibiotics
anticonvulsants
allopurinol
NSAIDs

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10
Q

How much of the surface of the body is covered in steven johnson syndrome

A

less than 10%

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11
Q

How much of the body is covered in toxic epidermal necrolysis

A

More than 30%

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12
Q

What is the presentation of steven johnson syndrome

A

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

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13
Q

What is the presentation of toxic epidermal necrolysis

A

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

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14
Q

What is erythema multiforme

A

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

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15
Q

In what order do the lesions appear in erythema multiforme

A

distal and then proximal

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16
Q

What is the management of erythema multiforme

A

Self limiting and resolves over 2 weeks

17
Q

What is DRESS

A

Drug reaction with eosinophilia and systemic symptoms

18
Q

What is the presentation of DRESS

A

Onset 2-8 weeks after drug exposure

fever and widespread rash

eosinophilia and derranged liver function

lymphadenopathy

19
Q

What is the treatment of DRESS

A

stop the drug which caused the drug reaction with eosinophilia and systemic symptoms

Start systemic steroids and then weave them off

20
Q

What is a pemphigus

A

antibodies targeted at desmosomes which causes flaccid blisters which rupture easily

21
Q

What is the site of pemphigus

A

face, axillae and groin

Nikolskys sign may be positive - skin scraped off with the fingers

22
Q

What is the difference between pemphigus and pemphigoid

A

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

23
Q

What are the common causes of pustular and erythrodermic psoriasis

A

infection and sudden withdrawal of oral or topical steroids

24
Q

How does erythrodermic and pustular psoriasis present

A

Rapid development of generalised erythema with or without clusters of pustules

Fever and raised WCC

25
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
26
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
27
Who is staphylococcus scalded skin syndrome most common in
children or in immunocompromised adults
28
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
29
What is the management of staphylococcal scalded syndrome
IV antibiotics and supportive care
30
What is urticaria
weal, wheal or hive: central swelling of variable size around erythema - causes dermal oedema
31
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
32
What is the treatment of acute urticaria (less than 6 weeka)
Oral antihistamine Short course oral steroid
33
What are contraindicated in acute urticaria
ACE inhibitors - can cause anioedema NSAIDS and opiates - exacerbate urticaria
34
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