Acute and Emergency Dermatology Flashcards
What is erythroderma?
Any inflammatory skin disease affecting >90% of total skin surface
What are the causes of erythroderma?
Psoriasis Eczema Drugs Cutaneous lymphoma Hereditary disorders
What are the consequences of skin failure?
Sepsis Hypo and hyperthermia Protein and fluid loss Renal impairment Peripheral vasodilation
What is the management for erythroderma?
Remove any offending drugs Careful fluid balance Good nutrition Temperature regulation Emollients Oral and eye care Anticipate and treat infection Manage itch Treat underlying cause
At what point in time are drug reactions likely to occur?
1-2 weeks after drug
What are some common drug causes of skin disease?
Stevens Johnson syndrome
Toxic epidermal necrolysis
Morbilliform exanthem
What are the clinical features of Stevens Johnson syndrome?
Fever, malaise, arthralgia
Rash
Mouth ulceration
Ulceration of other mucous membranes
What are the clinical signs of toxic epidermal necrolysis?
Prodomal febrile illness
Ulceration of mucous membranes
Rash
Sloughing of large areas of epidermis
What is the management for SJS and TEN?
Identify and stop culprit drug High dose steroids IV immunoglobulins Anti TNF therapy Ciclosporin
What are the long term complications of SJS and TEN?
Pigmentary skin changes Scarring Genital scarring Eye disease and blindness Nail and hair loss Joint contractures
What scale is used to determine and prognosis for SJS and TEN?
SCORTEN
What type of reaction is erythema multiforme?
Hypersensitivity reaction triggered by infection
What is the management of eyrthema multiforme?
Self limiting
Symptomatic and treat underlying cause
What does DRESS stand for?
Drug reaction with eosinophilia and systematic symptoms
What is the onset time of DRESS?
2-8 weeks after drug exposure
What are the clinical signs of DRESS?
Fever and widespread rash
Eosinophilia and deranged liver function
Lymphadenopathy
What is the treatment for DRESS?
Stop causative drug
Systemic steroids
Symptomatic treatment
What are the clinical features of pemphigus?
Flaccid blisters, rupture very easily
Ill defined erosions in mouth, nose, eyes and genital areas
What are the clinical signs of pemphigoid?
Tense and intact blisters
What area is targeted in pemphigus?
Antibodies targeted at desmosomes
What area is targeted in pemphigoid?
Antibodies targeted demo epidermal junction
What are the common causes of erythrodermic psoriasis and pustular psoriasis?
Infection
Sudden withdrawal of oral steroids or potent topical steroids
What are the clinical features of eyrthrodermic psoriasis and pustular psoriasis ?
Fever
Elevated WCC
Cluster of pustules
Rapid development of generalised erythema
What is the management for erythrodermic and pustular psoriasis?
Bland emollient
Avoid steroids
