Acute and emergency dermatology Flashcards
List some consequences of the skin failing
sepsis
hypo/hyper thermia
protein and fluid loss
peripheral vasodilation –> heart failure in extreme cases
Define erythoderma
any inflammatory skin disease affecting >90% of the total skin surface
Causes of erythoderma (conditions)
psoriasis eczema drugs cutaneous lymphoma hereditary disorders
Management of erythoderma
remove precipitating drug supportive therapy hydration appropriate setting manage itch emollient temperature regulation oral and eye care treat infection nutrition
What is the cause of SJS/TEN? give examples
secondary to drugs eg antibiotics, anti-histamines, allopurinol, NSAIDs
Is SJS or TEN more severe? Why?
TEN
Amount of surface epidermal detachment
Symptoms of SJS
fever, malaise and arthralgia
SJS rash
maculopapular
blisters
How much of skin surface is covered in erosions in SJS?
<10%
Mouth appearance in SJS
greyish white membrane
haemorrhagic crusting
How does TEN often present?
prodromal febrile illness
Are mucous membranes ulcerated in SJS or TEN?
both
TEN rash
macular, purpuric or blistering
rapidly becomes confluent and desquamation
What is nikolsky’s sign? What are 2 conditions it may be positive in?
blister formation by pressing on skin
TEN and pemphigus
Management of SJS/TEN?
stop precipitating drug
supportive therapy eg temp, infections
?? high dose steroids, immunoglobulins, anti TNF therapy, ciclosporin
SCORTEN - SJS/TEN prognosis
age >40 malignancy HR >120 initial epidermal detachment >10% serum urea >10 serum glucose >14 serum bicarbonate >20
Long term complications of SJS/TEN
scarring pigmentary skin changes eye disease and blindness nail and hair loss joint contractures
What is erythema multiforme triggered by?
hypersensitivity reaction triggered by infection - HSV then mycoplasma pneumonia
Onset of EM?
very rapid
Appearance of EM
from distal –> proximal
palms and soles, mucosal surfaces, pink macules become elevated and blister
Treatment of EM
self limiting
treat underlying cause
When does DRESS occur?
2-8 weeks after drug exposure
DRESS signs/symptoms
fever, widespread rash, eosinophilia, deranged liver function, lymphadenopathy
DRESS treatment
stop causative drug
symptomatic and supportive
systemic steroids
+/- immunosuppression or immunoglobulins
Pemphigus cause
antibodies targeted at desmosomes
Pemphigus appearance
watery blisters, intact blisters may not be seen, rupture easily, flaccid blisters
Where is pemphigus found?
mucous membranes, face, axilla, groin, eyes, nose
2 biopsies for pemphigus techniques
immunofluorescence
histopathology
Pemphigoid cause
antibodies directed at dermo-epidermal junction
Blisters in pemphigoid
intact epidermis forms roof of blister
usually tense and intact
Causes of erythodermic/pustular psoriasis
infection
sudden withdrawl of oral or potent topical steroids
Appearance of erythodermic/pustular psoriasis and symptoms
generalised erythema - groups of pustules
fever, infection, Increased WCC
Treatment of erythodermic/pustular psoriasis
bland emollient and systemic therapy
What should be avoided in erythodermic/pustular psoriasis treatment?
steroids
What is eczema herpeticum?
Disseminated herpes virus infection on a background of poorly controlled eczema
eczema herpeticum symptoms and signs
fever, lethargy, monomorphic blisters, punched out erosions, painful
eczema herpeticum treatment
acyclovir, mild topical steroid, ophthalmology
What is something to think about with eczema herpeticum in adults?
immunocompromised
People affected by staphylococcal scaled skin syndrome
children and immunocompromised adults
How does staphylococcal scaled skin syndrome start?
staph infection, diffuse erythematous rash, skin tenderness
How does staphylococcal scaled skin syndrome proceed?
desquamation, blistering, fever and irritability
staphylococcal scaled skin syndrome treatment
IV antibiotics, supportive care
Other names for urticarial
wheal or hives
Describe an urticaria lesion
central swelling of varying size surrounded by erythema
dermal oedema
itching and burning due to histamine release
Consequence of angioedema in urticaria
deeper swelling of skin or mucous membranes
4 causes of acute urticaria
food
drugs
idiopathic
infection - viral
Treatment of acute urticaria
oral antihistamine
oral steroids
2 things to avoid in urticaria
NSAIDs and opiates
3 causes of chronic urticaria
autoimmune/idiopathic
physical
vasculitic
Management of urticaria
antihistamine
anti leukotriene
immunomodulant
