Acute and Emergency Dermatology Flashcards
what is the consequence of mechanical barrier to infection failing?
sepsis
what are the consequences of temperature regulatioin failing?
Hypo- and Hyper- thermia
what are the consequences of fluid and electrolyte balance failing?
Protein and fluid loss
Renal impairment
Peripheral vasodilation
what are the causes of erythroderma?
Psoriasis Eczema Drugs Cutaneous Lymphoma Hereditary disorders Unknown
what are the principles of management?
Remove any offending drugs Careful fluid balance Good nutrition Temperature regulation Emollients – 50:50 Liquid Paraffin : White Soft Paraffin Oral and eye care Anticipate and treat infection Manage itch Disease specific therapy; treat underlying cause
what could a mild drug reaction be?
Morbilliform exanthem
what could severe reactions be?
Erythroderma, Stevens Johnson Syndrome/Toxic epidermal necrolysis, DRESS
what are clinical features of stevens johnson syndrome?
Fever, malaise, arthralgia
Rash
Mouth ulceration
Greyish white membrane
Haemorrhagic crusting
Ulceration of other mucous membranes
what does toxic epidermal necrolysis present with?
prodromal febrile illness
Ulceration of mucous membranes
Rash
what is the management of toxic epidermal necrolysis?
Identify and stop culprit drug as soon as possible
Supportive therapy
?High dose steroids
?IV immunoglobulins
?Anti-TNF therapy
?Ciclosporin
what are long term complications?
Pigmentary skin changes Scarring Eye disease and blindness Nail and hair loss Joint contactures
what is Erythema Multiforme
Hypersensitivity reaction usually triggered by infection
Most commonly HSV, then Mycoplasma pneumonia
what are the symptoms of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Fever and widespread rash
what are the clinical features of DRESS?
Eosinophilia and deranged liver function
Lymphadenopathy
+/- other organ involvement
whatare the clinical features of pemphigus?
Antibodies targeted at desmosomes
Skin – flaccid blisters, rupture very easily
Intact blisters may not be seen
Commonly affects mucous membranes
Ill defined erosions in mouth
Can also affect eyes, nose and genital areas
where are common sites for pemphigus?
face, axillae, groins
whats the difference between pemphigus and pemphigoid?
pemphigus-
Uncommon
Middle aged patients
Blisters very fragile – may not be seen intact
Mucous membranes usually affected
Patients may be very unwell if extensive
Treat with systemic steroids. Dress erosions. Supportive therapies
Pemphigoid
Common
Elderly patients
Blisters often intact and tense
Even if extensive, patients are fairly well systemically
Topical steroids may be sufficient if localised; systemic usually required if diffuse
how would you treat pemphigus?
systemic steroids. Dress erosions. Supportive therapies
how would you treat pemphigoid?
Topical steroids may be sufficient if localised; systemic usually required if diffuse
what are the common causes of Erythrodermic psoriais and Pustular Psoriasis
infection and sudden withdrawel of oral steroids or potent topical steroid
what are symptoms of Erythrodermic psoriais and Pustular Psoriasis
Rapid development of generalised erythema, +/- clusters of pustules
Fever, elevated WCC
what is Eczema Herpeticum
Disseminated herpes virus infection on a background of poorly controlled eczema
what is the treatment of Eczema Herpeticum
Aciclovir
Mild topical steroid if required to treat eczema
Treat secondary infection
Ophthalmology input if peri-ocular disease
what organism is responsible for Staphylococcal Scalded Skin Syndrome
staph. aureus
wht is the treatment of Staphylococcal Scalded Skin Syndrome
Require admission for IV antibiotics initially and supportive care
what is urticaria?
Weal, wheal or Hive: Central swelling of variable size, surrounded by erythema. Dermal oedema itching, sometimes burning Histamine release into dermis fleeting nature, duration: 1- 24 hours
what is Angioedema
Deeper swelling of the skin or mucous membranes
what are the causes of acute urticaria?
Idiopathic 50% Infection, usually viral 40% Drugs, IgE mediated 9% Food, IgE mediated 1%
what is the treatment for acute urticaria?
Oral antihistamine
Taken continuously
Up to 4 x dose
Short course of oral steroid may be of benefit if clear cause and this is removed
Avoid opiates and NSAIDs if possible (exacerbate urticaria)
what are the causes of chronic urticaria?
Autoimmune/Idiopathic 60% Physical 35% Vasculitic 5%
what is the management of chronic urticaria?
Omalizumab
Monoclonal antibody to IgE, mechanism of action unknown
Recently licensed for use in chronic spontaneous urticaria
300mg S/C ever 4 weeks
£6000 per year per patient
