Acute and Emergency Dermatology Flashcards

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1
Q

What are the consequences of failure of the skin?

A

–Sepsis

–Hypo- and Hyper- thermia

–Protein and fluid loss

–Renal impairment

–Peripheral vasodilation

•Can occasionally lead to cardiac failure

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2
Q

What is erythroderma?

A

Any inflammatory disease affecting over 90% of the total skin surface

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3
Q

What are the causes of erythroderma?

A

Psoriasis

Eczema

Drugs

Cutaneous lymphoma

Hereditary disorders

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4
Q

What are the principles of management of erythroderma?

A

Remove offending drugs

Maintain fluid balance

Good nutrition

Ensure patient remains at suitable temperature

Emollients - 50:50 liquid paraffin: white soft paraffin

Oral and eye care

Anticipate and treat infection

Manage itch

Disease specific therapy; treat underlying cause (e.g - eczema, psoriasis, cutaneous lymphoma)

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5
Q

When do drug reactions resulting in skin symptoms often occur?

A

Commonly 1-2 weeks after drug - within 72 hours if re-challenged

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6
Q

What are the mild and severe forms of drug reactions?

A

Mild - morbilliform exanthem

Severe - Erythroderma, stevens johnson syndrome/toxic epidermal necrolysis, DRESS

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7
Q

What causes the onset of Stevens johnson syndrome and toxic epidermal necrolysis?

A

Secondary to drugs -

–Antibiotics

–Anticonvulsants

–Allopurinol

–NSAIDs

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8
Q

What are the clinical features of SJS?

A

•Fever, malaise, arthralgia

Rash

–Maculopapular, target lesions, blisters

–Erosions covering <10% of skin surface

Mouth ulceration

–Greyish white membrane

–Haemorrhagic crusting

•Ulceration of other mucous membranes

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9
Q

What is the prodrome of TENS?

A

Febrile illness

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10
Q

What is the clinical presentation of toxic epidermal necrolysis?

A

Ulceration of mucous membranes

Rash:

–May start as macular, purpuric or blistering

–Rapidly becomes confluent

–Sloughing off of large areas of epidermis – ‘desquamation’ > 30% BSA

–Nikolsky’s sign may be positive

Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed

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11
Q

What is the management for TEN?

A

Identify and stop culprit drug as soon as possible

Supportive therapy

  • ?High dose steroids
  • ?IV immunoglobulins
  • ?Anti-TNF therapy
  • ?Ciclosporin
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12
Q

What score is used to determine the prognosis of TEN?

A

SCORTEN

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13
Q

What are the long term complications of TEN?

A

–Pigmentary skin changes

–Scarring

–Eye disease and blindness

–Nail and hair loss

–Joint contactures

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14
Q

What is erythema multiform?

A

Abrupt onset of 100s of lesions over 24 hours - hypersensitivty reaction usually triggered by infection (HSV and mycoplasma pneumonia)

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15
Q

Where are the lesions located in erythema multiforme?

A

Go from distal to proximal

Start at the palms and the soles

Includes mucosal surfaces

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16
Q

What happens to the lesions over time?

A

They evolve over 72 hours - pink macules become elevated and may blister in the centre

Resolves over 2 weeks

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17
Q

What does dress stand for?

A

Drug reaction with eosinophilia and systemic symptoms

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18
Q

What is the onset of dress?

A

2-8 weeks after drug exposure

19
Q

What are the clinical featrures of DRESS?

A

Fever and widespread rash

Eosiniphilia and deranged liver function

Lymphadenopathy

Possible involvement of other organs

20
Q

What is the management for dress?

A

Stop causative drug

Treat symptoms

Systemic steroids

Possible immunosuppressants or immunoglobulins

21
Q

What causes pemphigus?

A

Antibodies targeted at desmosomes

22
Q

What are the clinical features of pemphigus?

A

Flaccid blisters which rupture very easily

Common sites for the blisters include the face, axillae, groins

Nikolsky’s sign may be positive

Commonly affects the mucous membranes, ill defined erosions in the mouth

Can also affect the eyes, nose and genital areas

23
Q

Where are antibodies directed in pemphigoid?

A

•Antibodies directed at dermo-epidermal junction

24
Q

Describe the blisters in pemphigoid

A
  • Intact epidermis forms roof of blister
  • Blisters are usually tense and intact
25
Q

What are the differences between pehigus and pemphigoid?

A
26
Q

What are the causes of erythrodermic psoriasis and pustular psoriasis?

A

Infection

Sudden withdrawal of oral steroids or potent topical steroid

27
Q

What are the clinical features of Erythrodermic psoriais and Pustular Psoriasis?

A
  • Rapid development of generalised erythema, +/- clusters of pustules
  • Fever, elevated WCC
28
Q

What is the management of erythrodermic psoriasis and pustular psoriasis?

A

Exclude underlying infection, blsnd emollient and avoid steriods

Often requires initiation of systemic therapy

29
Q

What causes eczema herpeticum?

A

•Disseminated herpes virus infection on a background of poorly controlled eczema

30
Q

What are the clinical features of eczema herpeticum?

A

•Monomorphic blisters and “punched out” erosions

–Generally painful, not itchy

•Fever and lethargy

31
Q

What is the treatment for eczema herpeticum?

A

Treatment dose aciclovir

Mild topical steroid if required to treat eczema

Treat secondary infection

Ophthalmology input if peri-occular disease

In adults consider underlying immunocompromise

32
Q

What is staphylococcal scalded skin syndrome?

A

Initial staph infection, may be subclinical (common in children, but can occur in immunocompromised adults)

Diffuse erythematous rash with skin tenderness

Prominent in flexures

Blistering and desquamation follows

33
Q

What is the disease process of staphylococcal scalded skin syndrome?

A

Staphylococcus produces a toxin which targets desmoglein 1

34
Q

Despite the rash and the blistering, what other symptoms does the patient have?

A

Fever and irritability

35
Q

What is the treatment for staphylococcal scalded skin syndrome?

A

Admission for IV antibiotics initially and supportive care

Generally resolves over 507 days with treatment

36
Q

What is urticaria?

A

–Central swelling of variable size, surrounded by erythema. Dermal oedema

37
Q

What causes the itching / brining feeling of urticaria?

A

Histamine release into the dermis

38
Q

What is the disease progression of urticaria?

A

–fleeting nature, duration: 1- 24 hours

39
Q

What is angioedema?

A

–Deeper swelling of the skin or mucous membranes

40
Q

What are the causes of acute urticaria?

A

Idiopathic

Infection (viral)

Drugs, IgE mediated

Food. IgE mediated

41
Q

What is the treatment for acute urticaria?

A

•Oral antihistamine

–Taken continuously

–Up to 4 x dose

  • Short course of oral steroid may be of benefit if clear cause and this is removed
  • Avoid opiates and NSAIDs if possible (exacerbate urticaria)
42
Q

What is the definition of chronic urticaria?

A

History of over 6 weeks

43
Q

What are the causes of chronic urticaria?

A

Autoimmune / idiopathic (60%)

Physical (35%)

Vasculitic (5%)

Rarely a type 1 hypersensitvity reaction

44
Q

What is the management of chronic urticaria?

A