Acute and Emergency Dermatology Flashcards
What is erythroderma?
- Reddening of the skin due to inflammatory disease
- Affects >90% of the skin surface
What are some causes of erythroderma?
- Psoriasis
- Eczema
- Drugs
- Cutaneous lymphoma
- Hereditary disorders
- Idiopathic
Management of erythroderma?
- Hydration and electrolytes
- Apply Emollients
- Temperature regulation
- Anticipate / treat infections
- TREAT UNDERLYING CAUSE
What condition often occurs as a mild complication of adverse drug reactions? How does it appear?
Morbilliform exanthem
- Small red dots on the skin, with normal skin intervening (macules / maculopapules)
What are some severe skin conditions that may occur as a result of adverse drug reactions?
- Erythroderma
- Stevens Johnson Syndrome
- Toxic epidermal necrolysis
- DRESS (drug reaction with eosinophilia and systemic
symptoms)
What is a sign of Stevens Johnson Syndrome (SJS) or Toxic epidermal necrolysis?
Detachment of the epidermis
around 30% of epidermis in TEN, 10% ish in SJS
What are some symptoms of Stevens Johnson Syndrome (SJS)?
- Fever, malaise, arthralgia (joint pain)
- Rash (erosions on <10% of skin surface)
- Mouth (/ other mucous membrane) ulceration
What are some symptoms of Toxic epidermal necrolysis (TEN)?
- Flu like prodrome
- Ulceration of mucous membranes
- Erosion of >30% of the epidermis
Management of SJS / TEN?
- Identify and cease precipitating drug
High dose steroids? (inflammation)
IV immunoglobulins? (infection)
Anti-TNF therapy? (inflammation)
Ciclosporin? (immunosuppressant / inflammation)
What is SCORTEN in regards to SJS and TEN?
Way of measuring mortality prognosis for people with SJS / TEN based on comorbidities / symptoms: - Age >40 - Malignancy - Heart rate >120 - Initial epidermal detachment >10% - Serum urea >10 - Serum glucose >14 - Serum bicarbonate <20 Each counts for 1, SCORTEN of 5+ = >90% mortality
What are some long term complications associated with previous SJS / TEN?
- Pigmentary skin changes
- Scarring
- Eye disease / blindness
- Nail and hair loss
- Joint contractures
What is Erythema Multiforme? Symptoms / Signs?
Hypersensitivity reaction usually triggered by infection (HSV / mycoplasma pneumonia)
Abrupt onset of up to 100s of lesions over 24 hours. Start as pink macules, may develop to blisters etc. Develops distally first (palms / soles)
Management of Erythema Multiforme?
- Treat symptoms & underlying cause
- Actual condition is self limiting and usually resolves over 2 weeks
When do Erythema Multiforme, TEN / SJS, DRESS onset after initial drug use?
- Erythema Multiforme: Abrupt onset (w/in 24h)
- SJS/TEN: can be delayed onset
- DRESS: 2-8 weeks post drug exposure
What are the symptoms of Drug reaction with eosinophilia and systemic symptoms (DRESS)?
- Fever
- Widespread rash
- Eosinophilia (High WBC)
- Deranged liver function
- Lymphadenopathy
+/- other organ involvement
Management of DRESS?
Stop causative drug, treat symptoms, fluids
- Immunosuppressants / immunoglobulins
What is Pemphigus?
- A rare skin disorder characterized by blistering of your skin and mucous membranes
- Also includes erosions in mouth (+/- other mucous membranes)
- Common blister sites: face, axillae, groins
What is nikolsky’s sign? What conditions may it occur in?
- Dislodgement of intact superficial epidermis by a shearing force (pushing apart of skin)
- Pemphigus, Toxic Epidermal Necrolysis
What is Pemphigoid?
Autoimmune disease where antibodies are directed at the dermo-epidermal junction
Causes collections of in-tact blisters on the skin
How to tell between pemphigus and pemphigoid?
- Blisters fragile in pemphigus, intact in pemphigoid
- pemphigoid doesn’t tend to have systemic illness
- pemphigoid more common, occurs in elderly. pemphigus more common in middle age
- Topical steroids to treat pemphigoid, systemic steroids needed for pemphigus
