Acute and Emergency Dermatology

Question 1

List the 9 types of drug reaction.

Answer 1

Maculopapular/morbilliform
Papulosquamous
Photo-toxic
Pustular
Lichenoid
Fixed drug rash
Psoriasiform rash
Bullous rash
Itch (with no rash)

Question 2

List 6 types of drug which commonly cause drug reactions.

Answer 2

Antibiotics
NSAIDs
Chemotherapy agents
Psychotropic drugs
Anti-epileptic drugs
Cardiac drugs

Question 3

List 6 common causes of urticaria.

Answer 3

Unknown
Viral infections
Drug induced
Foods
Parasitic infections
Physical stimulants

Question 4

How would you treat urticaria? (4)

Answer 4

Antihistamines
Steroids
Immunosuppression
Omiluzimab

Question 5

List 3 causes of erythema multiforme.

Answer 5

Herpes simplex
Epstein Barr virus
Drug reaction

Question 6

What causes Ritter’s disease?

What is it also known by?

How do you treat it? (2)

Answer 6

Staphylococcal infection

Staphylococcal scalded skin syndrome (SSSS)

TREATMENT:
IV antibiotics
Supportive treatment

Question 7

List 3 causes of vaculitis.

Answer 7

Polyarteritis nodosa
Acute nephritis
Serum sickness

Question 8

List 5 causes of erythroderma.

Answer 8

Psoriasis
Eczema
Drug reactions
Cutaneous lymphoma
Others

Question 9

How would you treat erythroderma? (2)

Answer 9

Treat underlying skin disorder

Supportive treatment

Question 10

List 2 causes of toxic epidermal necrolysis (TEN).

Answer 10

Drug induced

Genetic predisposition to reacting to certain drugs

Question 11

What does TEN stand for?

Answer 11

Toxic epidermal necrolysis

Question 12

Describe the clinical features of TEN. (9)

Answer 12

Preceding flu-like illness

Red, painful skin rash

• Macules
• Diffuse erythema
• Target lesions
• Flaccid blisters
• Conversion of blisters into large sheets of peeling skin
• Exposure of dermis
• Nikolsky sign positive

Other organ involvement

Question 13

How would you manage TEN? (4)

Answer 13

Stop causative drug
Supportive treatment
Appropriate dressings
Immunosuppression (rare)

Question 14

Define “bullous pemphigoid”

Answer 14

A chronic, itchy, blistering autoimmune skin condition most common in the elderly; blisters most commonly occur on the limbs and may last for several days

Question 15

Describe the clinical features of bullous pemphigoid. Consider:

a) Features of rash (4)
b) Distribution (4)

Answer 15

RED, ITCHY RASH:

• Large, itchy blisters (up to 5cm diameter)
• Fluid-filled (clear, cloudy or blood-stained)
• Tense (i.e. skin is stretched taut)
• Non-scarring

DISTRIBUTION:
Upper arms
Thighs
Body folds 
Abdomen

Question 16

How would you treat bullous pemphigoid? (3)

What is the prognosis?

Answer 16

Steroids
Immunosuppression
Antibiotics

Treatment is NOT curative; but controls symptoms until disease disappears on its own

Question 17

Define “bullous pemphigus”.

Answer 17

A rare but serious autoimmune disease marked by successive outbreaks of blisters; the blisters are superficial and do not remain intact for long

Question 18

Describe the clinical features of bullous pemphigus. (4)

Answer 18

Painful

Fragile blisters (burst easily)
-Exposes unhealed skin

Non-scarring

Relapsing and remitting disease

Question 19

How would you manage bullous pemphigus? (3)

What is the prognosis?

Answer 19

Steroids
Immunosuppression
Antibiotics

Disease will NOT go away (unlike pemphigoid), but treatment can control symptoms

Question 20

Define “dermatitis herpetiformis”.

Answer 20

An uncommon, extremely itchy rash with symmetrical blistering, especially on the knees, elbows, buttocks and shoulders; associated with gluten sensitivity

Question 21

What causes dermatitis herpetiformis?

Answer 21

Coeliac disease

Question 22

How would you manage dermatitis herpetiformis? (2)

Answer 22

Dapsone (antibiotic)

Gluten free diet