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Dermatology AM > Acute and emergency dermatology > Flashcards

Acute and emergency dermatology Flashcards

1
Q

What are the functions of the skin?

A 
Mechanical barrier to infection
Temperature regulation
Fluid and electrolyte balance
Vit D synthesis
Sensation
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2
Q

What are the consequences of skin failure?

A 
Sepsis
Hypo and hyperthermia
Protein and fluid loss
Renal impairment
Peipheral vasodilation
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3
Q

What is erythroderma?

A

Widespread skin disease affecting >90% total skin surface

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4
Q

What can cause erythroderma?

A 
Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders
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5
Q

How often to drug reactions happen?

A

2-3% patients

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6
Q

What is a kind form of drug reaction?

A

Morbilliform exanthema

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7
Q

What are severe forms of drug reaction?

A

Erythroderma
Stevens Johnson syndrome/toxic epidermal necrolysis
DRESS

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8
Q

What causes SJS and TEN?

A

Drugs- antibiotics, anticonvulsants, allopurinol, NSAIDs

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9
Q

What are the clinical features of SJS?

A

Fever, malaise, arthralgia
Rash
Mouth ulceration
Ulceration of other mucous membranes

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10
Q

Describe the SJS rash

A

Maculopapular, taget lesions, blisters

Erosions covering <10% skin’s surface

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11
Q

Describe the mouth ulceration in SJS

A

Greyish white haemorrhage and haemorrhage crusting

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12
Q

What is the presentation of TEN?

A

Prodromal febrile illness
Ulceration of mucous membrane
Rash

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13
Q

Describe the TEN rash

A

May start as macular, purpuric or blistering
Rapidly becomes confluent
“Sloughing off” of large areas of epidermis
Nikolsky’s sign may be +

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14
Q

What is the management of SJS and TEN?

A

Identify and stop culprit drug
Supportive care- high dose steroids, IV immunoglobulins
Anti TNF therapy
Ciclosporin

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15
Q

What is the prognosis for SJS?

A

10% mortality

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16
Q

What is the prognosis for TEN?

A

30% mortality

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17
Q

What are the possible long term complications of SJS and TEN?

A 
Pigmentary skin changes
Scarring
Eye disease and blindness
Nail and hair loss
Joimt contractures
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18
Q

What is DRESS?

A

Drug reaction with eosinophilia and systemic symptoms

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19
Q

When is the onset of DRESS?

A

2-8 weeks after drug exposure

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20
Q

What are the signs and symptoms of DRESS?

A

Fever and widespread rash
Eosinophilia and deranged liver function
Lymphadenopathy
May or may not have other organ involvement

21
Q

Wat is the management of DRESS?

A

Stop causative drug

Symptomatic ans supportive- systemic steroids +/- immunosuppression or immunoglobulins

22
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infection causing abrupt onset of 100s of lesions over 24 hours

23
Q

What is the most common trigger of erythema multiforme?

A

HSV

24
Q

Describe the lesions in erythema multiforme

A

Distal and spread proximally
Palms and soles and mucosal surfaces most affected
Evolve over 72 hours- Pink macule become elevated and blister in the centre, target lesions

25
Q

What is the treatment of erythema multiforme?

A

Treat symptoms and underlying cause but self limiting

26
Q

How quickly does erythema multiforme resole?

A

2 weeks

27
Q

What is pemphigus?

A

Autoimmune condition with antibodies targeted at desmosomes

28
Q

What are the clinical features of pemphigus?

A

Flacid blisters that rupture easily
Nikolsky’s sign may be +
Ill defined erosions in mouth
Very unwell in extensive disease

29
Q

What sites are commonly affected by pemphigus?

A

Face
Axillae
Groin
Mucous membranes- mouth, eyes, nose, genitals

30
Q

What is the treatment of pemphigus?

A

Systemic steroids
Dress erosions
Supportive therapy

31
Q

What is pemphigoid?

A

Autoimmune condition causes by antibodies directed at demo-epidermal junction

32
Q

What is the presentation of pemphigoid?

A

Tense and intact blisters with roof formed by epidermis
Fairly systemically well
Common in older patients

33
Q

What is the treatment of pemphigoid?

A

Steroids- topical if localised, systemic if diffuse

34
Q

What are erythrodermic psoriasis and pustular psoriasis?

A

Psoriasis caused by infection or sudden steroid withdrawal

35
Q

What are the clinical features of erythrodermic and pustular psoriasis?

A

Rapid development od generalised erythema, with or without clusters of pustules
Fever, elevated WCC

36
Q

What is the treatment of erythrodermic and pustular psoriasis?

A

Bland emollient
Avoid steroids
Systemic therapy if severe

37
Q

What is eczema herpeticum?

A

Disseminated herpes virus infection on background of poorly controlled eczema

38
Q

What are the clinical features of eczema herpeticum?

A

Monomorphic blisters and punched out erosions- painful but not itchy
Fever and lethargy

39
Q

What is the treatment of eczema herpeticum?

A

Aciclovir
Mild topical steroid to treat eczema
Treat secondary ifection

40
Q

Who is staphylococcal scalded skin syndrome seen in?

A

Mainly children, some immunocompromised adults

41
Q

What are the clinical features of staphylococcal scalded skin syndrome?

A

Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation (skin peeling) follows
Fever and irritability

42
Q

What is the treatment of staphylococcal scaled skin syndrome?

A

IV antibiotics and supportive care

43
Q

What are the clinical features of urticaria?

A

Central swelling of variable size, surrounded by erythema
Dermal oedema
Itching, sometimes burning
Fleeting nature- 1-24 hours

44
Q

What are the 2 types of urticaria?

A

Acute

Chronic

45
Q

What is acute urticaria?

A

<6 week history

46
Q

Wat causes acute urticaria?

A

Idiopathic
Infection
Drugs- IgE mediated
Food- IgE mediated

47
Q

What is the treatment of acute urticaria?

A

Oral antihistamine
Short course of oral steroids
Avoid opiates and NSAIDs

48
Q

What causes chronic urticaria?

A

Autoimmune/idiopathic
Physical
VAsculitis

49
Q

What is the treatment of chronic urticaria?

A

Omalizumal- monoclonal antibody to IgE

Dermatology AM (9 decks)

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