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Dermatology > Acute And Emergency Dermatology > Flashcards

Acute And Emergency Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the causes of erythroderma?

A 
Psoriasis (unstable form) 
Eczema 
Drugs
Cutaneous lymphoma
Hereditary disorders
Unknown
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2
Q

What is erythroderma?

A

Inflammatory skin disease affecting > 90% of total skin surface

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3
Q

What would be the management of a patient with erythroderma?

A

Treat underlying cause i.e. withdraw causative drug
Emollients 50:50 liquid paraffin:white soft paraffin
Oral and eye care
Manage itch

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4
Q

What drugs can cause SJS / TEN?

A

Antibiotics
Anticonvulsants
Allopurinol
NSAIDS

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5
Q

What are the clinical features of Steven-Johnson syndrome?

A

Fever, ,malaise, arthralgia
Mouth ulceration + Ulceration of other mucous membranes
Rash - maculopapular, target lesions, blistering, erosions < 10% of skin

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6
Q

What are the clinical features of toxic epidermal necrosis (TEN)?

A

Predromal febrile illness
Ulceration of mucous membranes
Rash - start as macular, pupuric or blistering, sloughing off of large areas of epidermis (desquamination), Nikolsky’s sign may be positive
Affects 30% of skin

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7
Q

What is the management of SJS/ TEN?

A

Identify and stop drug

Supportive therapy i.e. steroids, IV immunoglobulins, anti TNF therapy, cyclosporine

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8
Q

What is the mortality rate for SJS and TEN?

A 
SJS = 10%
TEN = 30%
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9
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infection

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10
Q

What can trigger erythema multiforme?

A

HSV & mycoplasma pneumoniae

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11
Q

What is the presentation of erythema multiforme?

A

Abrupt onset of lesions
Works dismally - proximal
Pink macules become elevated and may blister in the center

Self limiting, resolves within 2 weeks

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12
Q

What does DRESS stand for?

A

Drug reactions with eosinophilia and systemic symptoms (DRESS)

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13
Q

When does DRESS occur after the drug administration?

A

Onset 2-8 weeks after drug exposure

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14
Q

What is the presentation of DRESS?

A

Non specific rash with systemic symptoms/signs

Widespread rash 
Fever 
Eosinophilia 
Deranged LFT’s 
Lymphadenopathy 
\+/- other organ involvement
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15
Q

What si the management of DRESS?

A

Stop causative drug
Symptomatic treatment
Systemic steroids
Immunosuppresion or immunoglobulins

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16
Q

What scoring system is used for determining SJS / TEN prognosis and what is included in it?

A

SCORTEN;

Age >40
Malignancy 
HR >?120
Initial epidermal detachment >10%
Serum urea > 10
Serum glucose > 14
Serum bicarbonate > 20
17
Q

What are the long term complications of SJS/TEN?

A 
Pigmentary skin changes
Scarring 
Eye disease and blindness
Nail and hair loss
Joint contactactures
18
Q

What is the main difference between SJS/TEN and erythema multiforme?

A

SJS/TEN is caused by rugs reactions

Erythema multiforme is caused by viral infection usually HSV

19
Q

How would you confirm erythema multiforme?

A

Viral swab for PCR

20
Q

What is a trigger for erythrodermic psoriasis and pustular psoriasis?

A

Infection

Sudden withdrawal of oral steroids or potent topical steroid

21
Q

What are the presentations of erythrodermic psoriasis and pustular psoriasis?

A

Rapid onset-of generalised erythema +/- clusters of pustules
Pyrexia
Elevated WCC

22
Q

What is eczema herpeticum?

A

Disseminated herpes virus infection on background of poorly controlled eczema

23
Q

What is the presentation of eczema herpeticum ?

A 
Monomorphic blisters and punched out erosions (all look the same)
Painful 
Not itchy 
Pyrexia
Lethargy
24
Q

What is the treatment for eczema herpeticum?

A

Aciclovir

25
Q

How do you differentiate between TEN and staphylocolccal scalded skin syndrome?

A

SSS will heal within a few days of antibiotics, also presence of staph
TEN will develop and get worse over weeks

26
Q

What is the treatment for staphylococcal scaleded skin syndrome?

A

IV Antibiotics

27
Q

What can trigger urticaria?

A

Idiopathic
Infection
Allergy (one of least causes of urticaria and is only acute not chronic)

28
Q

What is the treatment for acute urticaria?

A

High dose anti histamines

Steroids

29
Q

What are the causes of chronic urticaria?

A

Autoimmune
Physical i.e. cold, heat, pressure
Vasculitic
Type 1 hypersensitivity (rare)

30
Q

What is the treatment for chronic urticaria?

A

Antihistamines

Add biological

31
Q

What is the characteristic feature of urticaria?

A

Wheal

32
Q

what is the cause of pityriasis rosea?

A

cause isn’t completely understood but could be due to:

  • NSAIDS
  • ACE inhibitors
  • metronidazole
  • HSV 6/7
33
Q

What is the initial lesion of pityriasis rosea called?

A

heralds patch

34
Q

how would you describe the spread of pityriasis rosea?

A

Christmas tree distribution

35
Q

what is the treatment for pityriasis rosea?

A

spontaneously resolves within 12 weeks

treat pruritus with topical steroids, anti histamines, emollients

36
Q

what sex and age is pityriasis rosea most common in?

A

females

10-35yrs

37
Q

describe what the lesions look like in pityriasis rosea?

A

oval/round patch
central, wrinkled, salmon coloured area with darker red edge
fine scales around the centre of the patch

Dermatology (11 decks)

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