Acute And Emergency Dermatology Flashcards
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
How do you differentiate between TEN and staphylocolccal scalded skin syndrome?
SSS will heal within a few days of antibiotics, also presence of staph
TEN will develop and get worse over weeks
What is the treatment for staphylococcal scaleded skin syndrome?
IV Antibiotics
What can trigger urticaria?
Idiopathic
Infection
Allergy (one of least causes of urticaria and is only acute not chronic)
What is the treatment for acute urticaria?
High dose anti histamines
Steroids
What are the causes of chronic urticaria?
Autoimmune
Physical i.e. cold, heat, pressure
Vasculitic
Type 1 hypersensitivity (rare)
What is the treatment for chronic urticaria?
Antihistamines
Add biological
What is the characteristic feature of urticaria?
Wheal
what is the cause of pityriasis rosea?
cause isn’t completely understood but could be due to:
- NSAIDS
- ACE inhibitors
- metronidazole
- HSV 6/7
What is the initial lesion of pityriasis rosea called?
heralds patch
how would you describe the spread of pityriasis rosea?
Christmas tree distribution
what is the treatment for pityriasis rosea?
spontaneously resolves within 12 weeks
treat pruritus with topical steroids, anti histamines, emollients
what sex and age is pityriasis rosea most common in?
females
10-35yrs
describe what the lesions look like in pityriasis rosea?
oval/round patch
central, wrinkled, salmon coloured area with darker red edge
fine scales around the centre of the patch
