Acute Derma Flashcards
This deck covers the most common acute presenting dermatological conditions and how to manage them:
- Erythroderma
- Stevens Johnson Syndrome (SJS)
- Toxic Epidermal Necrolysis (TEN)
- Erythema Multiforme
- DRESS
- Pemphigus
- Pemphigoid
- Erythrodermic Psoriasis & Pustular Psoriasis
- Eczema Herpeticum
- Staphylococcal Scalded Skin Syndrome
- Urticaria
How do we manage any acute dermatological condition?
Remove any offending drugs Balance fluids Good nutrition Temperature Regulation Emollient Oral/Eye Care Manage symptoms (mainly itching) Anticipate/treat infections
What do we use for an emollient?
1:1 ratio
Liquid Paraffin : White Soft Paraffin
What is erythroderma?
A description rather than a condition
Its any inflammatory skin disease affecting >90% of the skin
What can cause erythroderma?
Psoriasis Drug Reactions Eczema Cutaneous lymphoma Hereditary disorders
What are Stevens Johnson Syndrome and Toxic Epidermal Necrolysis?
SJS/TEN are a spectrum of disease.
They are secondary to certain drugs.
Most notable for epidermal detachment
How do SJS/TEN present?
Prodromal Febrile illness (Fever/malaise/arthralgia)
Maculopapular Rash with target lesions and blisters
Mouth ulcers - Grey/white with haemorragic crusting
~NIkolsky’s Sign
Followed by epidermal detachment (skin sloughing)
What causes SJS/TEN?
Secondary to certain meds:
- Antibiotics
- Anticonvulsants
- NSAIDs
- Allopurinol
How do SJS/TEN diffeR?
In SJS <10% of the skin detaches
In TEN >30% detaches.
There is some variations in which they overlap
What is Nikolsky’s Sign?
Using a pencil eraser twisted against the skin to elicit blister formation,
If +ve a blister will form within a minute or so, indicating blister forming disease such as SJS/TEN of Pemphigus
How would you handle SJS/TEN?
Identify the causative drug and remove it.
Along with standard supportive therapy
What are the complications of SJS/TEN?
Pigment changes Scarring Eye disease/blindness Nail/hair loss Contractures
How do we asses the severity of a SJS/TEN case?
The Scorten Score predicts mortality, increasing based on the number of criteria the patient fits
What is included in the Scorten Score?
- Age >40
- Serum Glc > 14
- Serum Urea > 10
- Serum Bicarb <20
- Malignancy
- HR >120
- Initial epidermal detachment >10%
Patient presents with a 24 hour history of 100s of pink macules (target lesions) forming and blistering. Starting at their distal limbs (particularly palms and soles), what do they have?
Erythema Multiforme
What is erythema multiforme?
A hypersensitivity reaction to certain infections. Mainly HSV and mycoplasma pneumoniae.
Characterised by the abrupt onset of up to 100s of lesions
The patient presents with fever, a widespread rash and lymphadenopathy. On bloods the LFTs are deranged and Eosinophils raised. What is it?
DRESS
aka Drug Reaction with Eosinophils and systemic symptoms
Occurs 2-8 weeks after exposure to certain meds
How do we treat DRESS?
Stop the offending drug
Symptomatic and supportive therapy
Systemic steroid +/- immunosuppression or Immunoglobulins if necessary
What are Pemphigus ad pemphigoid?
Autoimmune conditions in which antibodies target desmosomes and the Dermo-Epidermal junction respectively
How does Pemphigus present?
Flaccid blisters (you may not see any intact ones) mainly on the axillae/face/groin
Nikolsky’s Sign
Mucous membrane erosion (mouth/nose/genitalia/eyes)
How does Pemphigoid present?
Domed blisters
Topped by the intact epidermis the are tense and generally intact.
What are the main differences between PEmphigus and Pemphigoid?
Pemphigus is rarer, affects the middle aged and causes systemic unwellness (plus the fragile blisters)
Pemphigoid is more common, affects the elderly and patients are generally systemically well. (plus the domed blisters)
How do we treat Pemphigus and pemphigoid?
Topical or systemic steroids
Plus dress any erosions and use supportive therapy
What are erythrodermic and pustular psoriasis?
Types of psoriasis caused by sudden steroid withdrawel and infection
