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
Q

What is eczema herpeticum

A

disseminated herpes virus infection on a background of poorly controlled eczema

Presents with painful erosions , fever and lethargy

treated with aciclovir

26
Q

What happens in staphylococcal scaled skin syndrome

A

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
Q

Who is staphylococcus scalded skin syndrome most common in

A

children or in immunocompromised adults

28
Q

How does staphylococcus scalded skin syndrome present

A

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
Q

What is the management of staphylococcal scalded syndrome

A

IV antibiotics and supportive care

30
Q

What is urticaria

A

weal, wheal or hive:
central swelling of variable size around erythema - causes dermal oedema

31
Q

How does urticaria present

A

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
Q

What is the treatment of acute urticaria (less than 6 weeka)

A

Oral antihistamine

Short course oral steroid

33
Q

What are contraindicated in acute urticaria

A

ACE inhibitors - can cause anioedema

NSAIDS and opiates - exacerbate urticaria

34
Q

What is the management of chronic urticaria

A

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