Acute And Emergency Dermatology Flashcards
(37 cards)
What are the causes of erythroderma?
Psoriasis (unstable form) Eczema Drugs Cutaneous lymphoma Hereditary disorders Unknown
What is erythroderma?
Inflammatory skin disease affecting > 90% of total skin surface
What would be the management of a patient with erythroderma?
Treat underlying cause i.e. withdraw causative drug
Emollients 50:50 liquid paraffin:white soft paraffin
Oral and eye care
Manage itch
What drugs can cause SJS / TEN?
Antibiotics
Anticonvulsants
Allopurinol
NSAIDS
What are the clinical features of Steven-Johnson syndrome?
Fever, ,malaise, arthralgia
Mouth ulceration + Ulceration of other mucous membranes
Rash - maculopapular, target lesions, blistering, erosions < 10% of skin
What are the clinical features of toxic epidermal necrosis (TEN)?
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
What is the management of SJS/ TEN?
Identify and stop drug
Supportive therapy i.e. steroids, IV immunoglobulins, anti TNF therapy, cyclosporine
What is the mortality rate for SJS and TEN?
SJS = 10% TEN = 30%
What is erythema multiforme?
Hypersensitivity reaction usually triggered by infection
What can trigger erythema multiforme?
HSV & mycoplasma pneumoniae
What is the presentation of erythema multiforme?
Abrupt onset of lesions
Works dismally - proximal
Pink macules become elevated and may blister in the center
Self limiting, resolves within 2 weeks
What does DRESS stand for?
Drug reactions with eosinophilia and systemic symptoms (DRESS)
When does DRESS occur after the drug administration?
Onset 2-8 weeks after drug exposure
What is the presentation of DRESS?
Non specific rash with systemic symptoms/signs
Widespread rash Fever Eosinophilia Deranged LFT’s Lymphadenopathy \+/- other organ involvement
What si the management of DRESS?
Stop causative drug
Symptomatic treatment
Systemic steroids
Immunosuppresion or immunoglobulins
What scoring system is used for determining SJS / TEN prognosis and what is included in it?
SCORTEN;
Age >40 Malignancy HR >?120 Initial epidermal detachment >10% Serum urea > 10 Serum glucose > 14 Serum bicarbonate > 20
What are the long term complications of SJS/TEN?
Pigmentary skin changes Scarring Eye disease and blindness Nail and hair loss Joint contactactures
What is the main difference between SJS/TEN and erythema multiforme?
SJS/TEN is caused by rugs reactions
Erythema multiforme is caused by viral infection usually HSV
How would you confirm erythema multiforme?
Viral swab for PCR
What is a trigger for erythrodermic psoriasis and pustular psoriasis?
Infection
Sudden withdrawal of oral steroids or potent topical steroid
What are the presentations of erythrodermic psoriasis and pustular psoriasis?
Rapid onset-of generalised erythema +/- clusters of pustules
Pyrexia
Elevated WCC
What is eczema herpeticum?
Disseminated herpes virus infection on background of poorly controlled eczema
What is the presentation of eczema herpeticum ?
Monomorphic blisters and punched out erosions (all look the same) Painful Not itchy Pyrexia Lethargy
What is the treatment for eczema herpeticum?
Aciclovir
