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Dermatology > Acute Derma > Flashcards

Acute Derma Flashcards

1
Q

This deck covers the most common acute presenting dermatological conditions and how to manage them:

A
  • 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
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2
Q

How do we manage any acute dermatological condition?

A 
Remove any offending drugs
Balance fluids
Good nutrition
Temperature Regulation
Emollient
Oral/Eye Care
Manage symptoms (mainly itching)
Anticipate/treat infections
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3
Q

What do we use for an emollient?

A

1:1 ratio

Liquid Paraffin : White Soft Paraffin

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4
Q

What is erythroderma?

A

A description rather than a condition

Its any inflammatory skin disease affecting >90% of the skin

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5
Q

What can cause erythroderma?

A 
Psoriasis
Drug Reactions
Eczema
Cutaneous lymphoma
Hereditary disorders
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6
Q

What are Stevens Johnson Syndrome and Toxic Epidermal Necrolysis?

A

SJS/TEN are a spectrum of disease.
They are secondary to certain drugs.
Most notable for epidermal detachment

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7
Q

How do SJS/TEN present?

A

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)

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8
Q

What causes SJS/TEN?

A

Secondary to certain meds:

  • Antibiotics
  • Anticonvulsants
  • NSAIDs
  • Allopurinol
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9
Q

How do SJS/TEN diffeR?

A

In SJS <10% of the skin detaches
In TEN >30% detaches.

There is some variations in which they overlap

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10
Q

What is Nikolsky’s Sign?

A

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

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11
Q

How would you handle SJS/TEN?

A

Identify the causative drug and remove it.

Along with standard supportive therapy

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12
Q

What are the complications of SJS/TEN?

A 
Pigment changes
Scarring
Eye disease/blindness
Nail/hair loss
Contractures
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13
Q

How do we asses the severity of a SJS/TEN case?

A

The Scorten Score predicts mortality, increasing based on the number of criteria the patient fits

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14
Q

What is included in the Scorten Score?

A
  • Age >40
  • Serum Glc > 14
  • Serum Urea > 10
  • Serum Bicarb <20
  • Malignancy
  • HR >120
  • Initial epidermal detachment >10%
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15
Q

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?

A

Erythema Multiforme

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16
Q

What is erythema multiforme?

A

A hypersensitivity reaction to certain infections. Mainly HSV and mycoplasma pneumoniae.

Characterised by the abrupt onset of up to 100s of lesions

17
Q

The patient presents with fever, a widespread rash and lymphadenopathy. On bloods the LFTs are deranged and Eosinophils raised. What is it?

A

DRESS
aka Drug Reaction with Eosinophils and systemic symptoms

Occurs 2-8 weeks after exposure to certain meds

18
Q

How do we treat DRESS?

A

Stop the offending drug
Symptomatic and supportive therapy

Systemic steroid +/- immunosuppression or Immunoglobulins if necessary

19
Q

What are Pemphigus ad pemphigoid?

A

Autoimmune conditions in which antibodies target desmosomes and the Dermo-Epidermal junction respectively

20
Q

How does Pemphigus present?

A

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)

21
Q

How does Pemphigoid present?

A

Domed blisters

Topped by the intact epidermis the are tense and generally intact.

22
Q

What are the main differences between PEmphigus and Pemphigoid?

A

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)

23
Q

How do we treat Pemphigus and pemphigoid?

A

Topical or systemic steroids

Plus dress any erosions and use supportive therapy

24
Q

What are erythrodermic and pustular psoriasis?

A

Types of psoriasis caused by sudden steroid withdrawel and infection

25
Q

How do Erythrodermic & Pustular PSoriasis present?

A

Fever
Rapid onset of erythema +/- pustule clusters

Elevated WCC

26
Q

How would you manage erythrodermic and pustular psoriasis?

A

Systemic Therapy
Avoid steroids
Rule out underlying infection
Bland emollient

27
Q

A patient with eczema presents with monomorphic blisters, painful “punched out” erosions, fever & lethargy. what do you suspect?

A

Eczema Herpeticum

A disseminated Herpes infection on top of poorly controlled eczema

28
Q

How would you treat a case of eczema herpeticum?

A

Aciclovir for the HSV

Mild topical steroid for the eczema

Ophthalmology review if periocular

29
Q

A patient comes in having had a diffuse erythematous rash with tenderness that progressed to blistering and desquamation. They’re also febrile and irritable, what do we expect?

A

Staphylococcal Scalded Skin Syndrome

A staph infection has released toxins targeting Demoglein 1 causing blisters and epidermal detachment

30
Q

How do we treat a patient with Staph Scalded Skin SYndrome?

A

IV Antibiotics and supportive care

31
Q

Define Urticaria?

A

A central swelling surrounded by erythema, may itch or burn.
Individual swellings are fleeting, dissapearing within 1-24 hours

Often comes with angioedema (A deeper swelling of soft tissues)

32
Q

Describe the pathology of urticaria?

A

A histamine release into the dermis

33
Q

What causes urticaria?

A

Acute:

  • 50% idiopathic
  • 40% infection
  • 10% IgE mediated (Drugs & food)

Chronic:

  • 60% autoimmune
  • 35% physical
  • 5% vasculitis
  • Rarely Type 1 Hypersensitivity
34
Q

How would you treat a case of acute (<6wks) urticaria?

A
  • Oral Antihistamine
  • ~Short course of oral steroids if severe
  • Avoid Opiates/NSAIDs
35
Q

How would you treat a case of Chronic (>6wks) Urticaria?

A

Identify and avoid the triggers.

1) Antihistamine
2) Increased dose of antihistamine
3) Anti-leukotriene
4) Immunomodulant e.g. Omalizumab

Dermatology (14 decks)

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