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Dermatology > Acute and Emergency Dermatology > Flashcards

Acute and Emergency Dermatology Flashcards

1
Q

What % of body mass does skin make up in the average person?

A

10%

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2
Q

Consequences of failure of the skin

A 
Sepsis
Hyper and hypo thermia
Protein and fluid loss
Renal impairment 
Peripheral vasodilation that can occasionally lead to cardiac failure
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3
Q

Definition of erythroderma

A

Any inflammatory skin disease affecting > 90% of the total skin surface

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4
Q

Causes of erythroderma

A 
Psoriasis
Eczema
Drugs
Cutaenous lymphoma
Hereditary disorders
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5
Q

Treatment of erythroderma

A 
ITU / burns unit
Remove any offending drugs 
Careful fluid balance
Good nutrition 
Temp regulation 
Emollients - 50:50 liquid paraffin : white soft paraffin 
Oral and eye care
Anticipate and treat infection 
Manage itch  
Treat underlying cause
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6
Q

When do drug reactions commonly occur?

A

1 - 2 weeks after drug

Within 72 hours if rechallenged

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7
Q

Mild drug reactions affecting the skin causes what?

A

Morbilliform exanthem

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8
Q

Severe drug reactions affecting the skin causes what?

A

Erythroderma
Steven johnstons syndrome / toxic epidermal necrolysis
DRESS

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9
Q

Which of SJS and TEN is less severe?

A

SJS

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10
Q

What drugs can cause SJS and TENS?

A

Antibiotics
Anticonvulsants
Allopurinol
NSAIDs

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11
Q

Presentation of SJS

A 
Fever
Malaise 
Arthralgia 
Rash 
- maculopapular
- target lesions
- blisters
Mouth ulceration 
- greyish white membrane 
- haemorrhagic crusting 
Ulceration of other mucous membranes
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12
Q

Definition of arthralgia

A

Joint pain

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13
Q

Presentation of TEN

A 
Prodromal febrile illness
Ulceration of mucous membranes 
Rash 
- may start at macular, purpuric or blistering 
- rapidly becomes confluent 
- desquamation > 30% BSA
Nikolsky's Sign may be +ve
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14
Q

Definition of prodromal

A

Relating to or denoting the period between the appearance of initial symptoms and the full development of a rash and fever

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15
Q

What is desquamation?

A

Sloughing off large areas of epidermis

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16
Q

Definition of Nikolsky’s sign

A

Rub the skin and lose the skin surface over the area that you rub

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17
Q

Treatment of SJS / TEN

A 
Stop drug
Supportive 
Possible
- high dose steroids
- IV immunoglobulins
- anti TNF therapy 
- ciclosporin
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18
Q

Mortality of SJS

A

10%

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19
Q

Mortality of TEN

A

30%

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20
Q

What scoring system is used for SJS / TEN?

A

SCROTEN

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21
Q

What does SCROTEN look at?

A 
Age > 40 
Malignancy 
HR > 120 
Initial epidermis detachment >1-%
Serum urea >10
Serum glucose >14 
Serum bicarbonate <20%
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22
Q

Long term complications of SJS / TEN

A 
Pigmentary skin changes
Scarring
Eye disease and blindness 
Nail and hair loss
Joint contractures
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23
Q

What is erythema multiforme?

A

Hypersensivity reaction usually triggered by infection.

Abrupt onset of up to 100s of lesions over 24 hours

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24
Q

2 most common causes of erythema multiforme

A

HSV most common

Then mycoplasma pneumonia

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25
Q

Presentation of erythema multiforme

A

Abrupt onset of up to 100s of lesions over 24 hours
Distal -> proximal
Palms and soles
Mucosal surfaces (EM major)
Evolve over 72 hours
- pink macules, become elevated and may blister in the centre
- target lesions

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26
Q

How long does erythema multiforme take to resolve?

A

Over 2 weeks

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27
Q

What does DRESS stand for?

A

Drug Reaction with Eosinophilia and Systemic Symptoms

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28
Q

Mortality of DRESS

A

10%

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29
Q

When does DRESS occur?

A

Onset 2 - 8 weeks after drug exposure

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30
Q

Presentation of DRESS

A 
Fever
Widespread rash 
Eosinophilia 
Deranged liver function 
Lymphadenopathy 
\+/- other organ involvement
31
Q

Treatment of DRESS

A

Stop causative drug
Symptomatic and supportive
Systemic steroids
+/- immunosuppression or immunoglobulins

32
Q

Pathology of pemphigus

A

Antibodies targeted at desmosomes

33
Q

Presentation of pemphigus

A

Flaccid blisters which rupture very easily
Intact blisters may not be seen
May be Nikolsky’s sign +ve

34
Q

Where do you get the lesions of pemphigus?

A 
Face
Axillae 
Groin 
Mucous membranes 
Ill defined erosions in mouth
35
Q

Pathology of pemphigoid

A

Antibodies directed at dermo-epidermal junction

36
Q

Presentation of pemphigoid

A

Intact epidermis forms the roof of the blister

Blisters are usually tense and in tact

37
Q

Who gets pemphigus?

A

Middle aged patients

38
Q

How common is pemphigus?

39
Q

Treatment of pemphigus

A

Systemic steroids
Dress erosions
Supportive therapies

40
Q

How common is pemphigoid?

41
Q

Who gets pemphigoid?

42
Q

If extensive disease, how are pemphigus patients?

A

Very unwell

43
Q

If extensive disease, how are pemphigoid patients?

A

Fairly well systematically

44
Q

Treatment of pemphigoid patients

A

Topical steroids if localised

Systemic if diffuse

45
Q

Can erythrodermic psoriasis and pustular psoriasis occur if you haven’t had psoriasis before?

46
Q

Common causes of erythrodermic or pustular psoriasis

A

Infection

Sudden withdrawal of oral steroids or potent topical steriod

47
Q

Presentation of erythrodermic / pustular psoriasis

A

Rapid development of generalised erythema
+/- clusters of pustules
Fever
Elevated WCC

48
Q

Treatment of erythrodermic / pustular psoriasis

A

Exclude underlying infection
Bland emollient
Avoid steroids
Systemic therapy Often needed

49
Q

What is eczema herpeticum?

A

Disseminated herpes virus infection on a background of poorly controlled eczema

50
Q

Presentation of eczema herpeticum

A 
Monomorphic blisters and "punched out" erosions 
Generally Painful 
Not itchy 
Fever
Lethargy
51
Q

Treatment of eczema herpeticum

A

Aciclovir
Mild topical steroid if required to treat eczema
Treat secondary infection
Ophthalmology input if peri-ocular disease

52
Q

If an adult and have eczema herpeticum, what should be considered?

A

Underlying immunocompromise

53
Q

Who does staphylococcal scaled skin syndrome (SSSS) occur in?

A

Children

Immunocompromised adults

54
Q

Presentation of SSSS

A 
Initial staph infection (may be subclinical)
Diffuse erythematous rash 
Skin tenderness 
More prominent in flexures 
Blistering and desquamation follows
Fever
Irritability
55
Q

Why does blistering and desquamation occur in SSSS?

A

Staphylococcus produces toxin which targets desmoglein 1

56
Q

Treatment of SSSS

A

IV antibiotics

Supportive care

57
Q

How long does SSSS take to resolve with treatment?

A

5 - 7 days

58
Q

Other names for urticaria

A

Weal

Hives

59
Q

What is urticaria?

A

Central swelling of variable size, surrounded by erythema

Dermal oedema

60
Q

Presentation of urticaria

A

Swellings surrounded by erythema
Itching
Sometimes burning
Fleeting nature

61
Q

Duration of urticaria

A

1 - 24 hours

62
Q

What is angioedema?

A

Deeper swelling of the skin or mucous membranes

63
Q

Definition of acute urticaria

A

< 6 week history

64
Q

Causes of acute urticaria

A

Idiopathic 50%
Infection, usually viral 40%
Drugs, IgE mediated 9%
Food, IgE mediated 1%

65
Q

Treatment of acute urticaria

A

Oral antihistamine

66
Q

What drugs exacerbate urticaria?

A

Opiates

NSAIDs

67
Q

Definition of chronic urticaria

A

> 6 week history

68
Q

Causes of chronic urticaria

A

Autoimmune/idiopathic 60%
Physical 35%
Vasculitic 5%
Rarely type 1 hypersensitivity reaction

69
Q

Treatment of chronic urticaria

A

Omalizumab

70
Q

What is Omalizumab?

A

Monoclonal antibody to IgE

71
Q

What complications are monitored for in an inpatient with erythroderma?

A

Dehydration
Infection
High output heart failure

72
Q

Bullous pemphigoid vs pemphigus vulgaris

A

Bullous pemphigoid - NO mucosal involvement

Pemphigus vulgaris - mucosal involvement

73
Q

Children with new onset purpura need to be admitted and tested to exclude what two conditions?

A

ALL

Meningococcal septicaemia

74
Q

When should superficial dermal burns be referred to secondary care?

A

> 3% TBSA adults
2% TBSA children
Also if involve face, hands, feet, perineum, genitalia, any flexure, circumferential burns of the limbs, torso or neck

Dermatology (11 decks)

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