Acute and emergency dermatology

Question 1

What are the functions of the skin?

Answer 1

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

Question 2

What are the consequences of skin failure?

Answer 2

Sepsis
Hypo and hyperthermia
Protein and fluid loss
Renal impairment
Peipheral vasodilation

Question 3

What is erythroderma?

Answer 3

Widespread skin disease affecting >90% total skin surface

Question 4

What can cause erythroderma?

Answer 4

Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders

Question 5

How often to drug reactions happen?

Answer 5

2-3% patients

Question 6

What is a kind form of drug reaction?

Answer 6

Morbilliform exanthema

Question 7

What are severe forms of drug reaction?

Answer 7

Erythroderma
Stevens Johnson syndrome/toxic epidermal necrolysis
DRESS

Question 8

What causes SJS and TEN?

Answer 8

Drugs- antibiotics, anticonvulsants, allopurinol, NSAIDs

Question 9

What are the clinical features of SJS?

Answer 9

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

Question 10

Describe the SJS rash

Answer 10

Maculopapular, taget lesions, blisters

Erosions covering <10% skin’s surface

Question 11

Describe the mouth ulceration in SJS

Answer 11

Greyish white haemorrhage and haemorrhage crusting

Question 12

What is the presentation of TEN?

Answer 12

Prodromal febrile illness
Ulceration of mucous membrane
Rash

Question 13

Describe the TEN rash

Answer 13

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

Question 14

What is the management of SJS and TEN?

Answer 14

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

Question 15

What is the prognosis for SJS?

Answer 15

10% mortality

Question 16

What is the prognosis for TEN?

Answer 16

30% mortality

Question 17

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

Answer 17

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

Question 18

What is DRESS?

Answer 18

Drug reaction with eosinophilia and systemic symptoms

Question 19

When is the onset of DRESS?

Answer 19

2-8 weeks after drug exposure

Question 20

What are the signs and symptoms of DRESS?

Answer 20

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

Question 21

Wat is the management of DRESS?

Answer 21

Stop causative drug

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

Question 22

What is erythema multiforme?

Answer 22

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

Question 23

What is the most common trigger of erythema multiforme?

Answer 23

HSV

Question 24

Describe the lesions in erythema multiforme

Answer 24

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

Question 25

What is the treatment of erythema multiforme?

Answer 25

Treat symptoms and underlying cause but self limiting

Question 26

How quickly does erythema multiforme resole?

Answer 26

2 weeks

Question 27

What is pemphigus?

Answer 27

Autoimmune condition with antibodies targeted at desmosomes

Question 28

What are the clinical features of pemphigus?

Answer 28

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

Question 29

What sites are commonly affected by pemphigus?

Answer 29

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

Question 30

What is the treatment of pemphigus?

Answer 30

Systemic steroids Dress erosions Supportive therapy

Question 31

What is pemphigoid?

Answer 31

Autoimmune condition causes by antibodies directed at demo-epidermal junction

Question 32

What is the presentation of pemphigoid?

Answer 32

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

Question 33

What is the treatment of pemphigoid?

Answer 33

Steroids- topical if localised, systemic if diffuse

Question 34

What are erythrodermic psoriasis and pustular psoriasis?

Answer 34

Psoriasis caused by infection or sudden steroid withdrawal

Question 35

What are the clinical features of erythrodermic and pustular psoriasis?

Answer 35

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

Question 36

What is the treatment of erythrodermic and pustular psoriasis?

Answer 36

Bland emollient Avoid steroids Systemic therapy if severe

Question 37

What is eczema herpeticum?

Answer 37

Disseminated herpes virus infection on background of poorly controlled eczema

Question 38

What are the clinical features of eczema herpeticum?

Answer 38

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

Question 39

What is the treatment of eczema herpeticum?

Answer 39

Aciclovir Mild topical steroid to treat eczema Treat secondary ifection

Question 40

Who is staphylococcal scalded skin syndrome seen in?

Answer 40

Mainly children, some immunocompromised adults

Question 41

What are the clinical features of staphylococcal scalded skin syndrome?

Answer 41

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

Question 42

What is the treatment of staphylococcal scaled skin syndrome?

Answer 42

IV antibiotics and supportive care

Question 43

What are the clinical features of urticaria?

Answer 43

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

Question 44

What are the 2 types of urticaria?

Answer 44

Acute | Chronic

Question 45

What is acute urticaria?

Answer 45

<6 week history

Question 46

Wat causes acute urticaria?

Answer 46

Idiopathic Infection Drugs- IgE mediated Food- IgE mediated

Question 47

What is the treatment of acute urticaria?

Answer 47

Oral antihistamine Short course of oral steroids Avoid opiates and NSAIDs

Question 48

What causes chronic urticaria?

Answer 48

Autoimmune/idiopathic Physical VAsculitis

Question 49

What is the treatment of chronic urticaria?

Answer 49

Omalizumal- monoclonal antibody to IgE