Acute and Emergency Dermatology

Question 1

What are the different groups of acute skin reactions and triggers?

Answer 1

Drug reactions
Toxic epidermal necrolysis
Stevens Jonson syndrome
Erythema multiforme
Urticaria
Vasclitis
Erythroderma

Question 2

What are the different types of skin drug reactions?

Answer 2

Maculopapular
Urticarial
Morbilliform
Papulosquamous
Photo-toxic
Pustular
Lichenoid
Fixed drug rash
Bullous
Itch without rash

Question 3

What drugs can commonly cause acute rashes?

Answer 3

Antibiotics - penicillins, trimethoprim
NSAIDs
Chemotherapeutic agents
Psychotropic agents - chlorpromazine
Anti-epileptic agents - lamotrigine, carbamazepine
Cardiac drugs - beta blockers, ACE inhibitors, anticoagulants

Question 4

What drugs commonly cause psoriasiform rash?

Answer 4

Lithium

Beta blockers

Question 5

What is drug induced psoriasiform rash?

Answer 5

Psoriasis-like, well-demarcated pink erythema with scale
Sudden onset
No family history

Question 6

A fixed drug rash always occurs in the same area with the same drug. T/F?

Answer 6

True

Question 7

What can trigger vasculitis?

Answer 7

Infection
Drugs
Connective tissue disease e.g. RA

Question 8

Patients with vasculitis are less unwell than those with an meningococcal rash. T/F?

Answer 8

True

Question 9

How can systemic vasculitis be checked for?

Answer 9

Renal BP

Urinalysis

Question 10

Toxic epidermal necrolysis is usually drug induced. T/F?

Answer 10

True

Question 11

There is a spectrum disease from Steven Johnson syndrome to toxic epidermal necrolysis. If less than 10% of the skin is involved then what is this classified as?

Answer 11

Steven Johnson syndrome

Question 12

When is Steven Johnson syndrome most severe?

Answer 12

When there is mucous membrane involvement

Question 13

Toxic epidermal necrolysis is severely painful. T/F?

Answer 13

False - it causes anaesthesia

Question 14

How can fluid imbalance in toxic epidermal necrolysis be assessed?

Answer 14

SCORTEN severity scale

Question 15

How can toxic epidermal necrolysis be managed?

Answer 15

Stop suspected causative drug
Special mattresses/sheets
Infection control - prophylaxis
Non-adherent dressings
Urology/gynaecology/ophthalmology input

Question 16

What can cause erythema multiform?

Answer 16

HSV
EBV
Occasionally drugs

Question 17

There are target lesions in erythema multiform. This can progress to toxic epidermal necrolysis. T/F?

Answer 17

False- there are target lesions which never progress to TEN

Question 18

Give examples of immunobullous disorders?

Answer 18

Bullous pemphigoid
Mucous membrane pemphigoid
Paraneoplastic pemphigoid
Pemphigus
Dermatitis herpetiformis

Question 19

What condition is dermatitis herpetiformis associated with?

Answer 19

Coeliac disease

Question 20

What is the cause of pemphigus?

Answer 20

Autoantibodies to various skin components o.e.basement membrane proteins in BP on skin biopsy

Question 21

How should immunobullous disorders be investigated?

Answer 21

Skin biopsy with immunofluorescence

Question 22

How should dermatitis herpetiformis be treated?

Answer 22

Topical steroids
GF diet
Oral dapsone

Question 23

How should immuobullous disorders be treated?

Answer 23

Reduce autoimmune reaction via topical and oral corticosteroids
Steroid sparing agents e.g. azathioprine, anti-inflammatory tetracyclines
Burst any blisters
Dressings and infection control
Check for oral/mucosal involvement
Consider screen for underlying malignancy

Question 24

What is urticaria?

Answer 24

Itchy

Wheals (hives)

Question 25

For how long do the lesions last in urticaria?

Answer 25

Less than 24 hours

Question 26

Urticarial lesions do not scar. T/F?

Answer 26

True

Question 27

For how long does acute urticaria last?

Answer 27

<6 weeks

Question 28

For how long does chronic urticaria last?

Answer 28

>6 weeks

Question 29

In urticaria there can be angioedema but not anaphylaxis. T/F?

Answer 29

True

Question 30

What are the possible causes of urticaria?

Answer 30

Immune mediated type one IgE mediated response | Non-immune mediated caused by direct mast cell degranulation e.g. opiates, antibiotics, contrast media and NSAIDs

Question 31

What investigations should be conducted for an urticarial rash?

Answer 31

No investigations as it is not normally allergy driven and so there is no patch testing

Question 32

How is urticaria treated?

Answer 32

``` Antihistamines Steroids Phototherapy Immunosuppression Omalizumab ```

Question 33

What are the possible causes of acute urticaria?

Answer 33

Viral infections Medication (NSAIDs, aspirin, ACE inhibitors) Foods and food additives Parasitic infections Physical. stimulants (e.g. cold pressure, solar, cholinergic and aquagenic)

Question 34

Dermographism is seen in urticaria. T/F?

Answer 34

True

Question 35

What are the causes of erythroderma?

Answer 35

Psoriasis Eczema Drug reaction Cutaneous lymphoma

Question 36

How is erythroderma treated?

Answer 36

Supportive treatments - fluid and temperature balance restored Treatment of underlying skin disorder

Question 37

What drugs can cause maculopapular rashes?

Answer 37

Antibiotics

Question 38

What drugs can cause photosensitive rashes?

Answer 38

Diuretics | Antibiotics

Question 39

What drugs can cause severe idiosyncratic reactions?

Answer 39

Anti epileptics | Antibiotics

Question 40

What drugs can cause urticarial reactions?

Answer 40

Antibiotics Opiates NSAIDs ACE inhibitors