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Year 2 - Dermatology > Acute + emergency > Flashcards

Acute + emergency Flashcards

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Dermatology Board Prep flashcards
1
Q

Consequence of the loss of the mechanical barrier function against infection of the skin

A

sepsis

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2
Q

Consequence of loss of temp regulation function of skin

A

Hypo/hyperthermia

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3
Q

Consequences of the loss of fluid and electrolyte balance function of the skin

A

Protein and fluid loss
Renal impairment
Peripheral vasodilation

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4
Q

What is erythroderma

A

Descriptive term that describes
-intense and usually widespread reddening/erythema of the skin due to inflammatory skin disease; affecting at least 90% of the body surface area

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5
Q

Name some acute/emergency dermatological conditions

A

Erythroderma

Drug reactions
-Stevens-Johnson syndrome / toxic epidermal necrolysis spectrum

Extensive blistering conditions

Generalised pustular psoriasis

Eczema herpeticum

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6
Q

Causes of erythroderma (reddening/erythema of the skin due to inflammatory skin disease; affecting at least 90% of the body surface area)

A

Psoriasis - commonest
Eczema
Drug induced - e.g. vancomycin

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7
Q

What skin syndrome can excessive vancomycin cause

A

Red man syndrome

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8
Q

Principles of management of erythroderma (9)

A 
Remove the inducing drug if that's the cause
Fluid balance
Good nutrition
Regulate temp
Emmolient - to moisturise
Oral/eye care
Treat infection if present
Manage itch
Treat underlying cause - different for each person
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9
Q

Name 4 severe drug induced reactions of the skin

A

Erythroderma

Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN)

DRESS

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10
Q

What is Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN)

A

2 essentially interchangeable names for the same condition

  • severe EPIDERMAL detachment with mucocutaneous complications
  • It is an immune reaction to foreign antigens
  • TEN is the more severe form
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11
Q

Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN) are secondary to use of what drug types (3)

A

Anticonvulsants
Antibiotics
NSAIDs

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12
Q

Difference between Syndrome (SJS) and Toxic epidermal necrolysis (TEN)

A

SJS has <10% total body surface area

TEN has >30% TBSA involvement

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13
Q

Symptoms (2) /signs (4) of Syndrome (SJS) and Toxic epidermal necrolysis (TEN)

A

Symptoms

  • malaise
  • arthralgia

Signs

  • Fever
  • Rash
  • erosions/ulceration of mouth/eyes/lips/genitals/anywhere with mucosal membrane
  • nikolsky’s sign - epidermal layer easily sloughs/peels off when pressure is applied
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14
Q

Diagnosis of Syndrome (SJS) and Toxic epidermal necrolysis (TEN) based on what

A

clinical presentation + confirmed with skin biopsy

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15
Q

Describe the characteristics of the rash in Syndrome (SJS)/ Toxic epidermal necrolysis (TEN)

A

May start as macular lesions (small/red/flat)

May get blistering

May get flat atypical target lesions

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16
Q

Principles of management of Syndrome (SJS) and Toxic epidermal necrolysis (TEN) (2)

A

Stop the offending drug

Supportive therapy

  • dressings
  • topical antibiotics
  • emollients
  • eye care
  • analgesia
  • IV fluids for hydration

+/- high dose corticosteroids

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17
Q

Prognosis/mortality score of Syndrome (SJS) and Toxic epidermal necrolysis (TEN) can be depicted based on a scoring system called SCORTEN - what score indicates low/high mortality

A

Low - 0-2

High - 3-5;
-5 = >90% mortality

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18
Q

Why should all patients manifesting signs and symptoms of SJS/TEN have an ophthalmological consultation upon admission

A

as can get erosion/ulceration of eye so need to preserve vision and reduce complications

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19
Q

What’s erythema multiforme + describe the onset period

A

Acute self limiting, hypersensitivity reaction usually triggered by infection - HSV or Mycoplasma pneumoniae

Abrupt onset of 24-48 hours where 100s of lesions appear all at once then stop appearing after this; lasts for 1 to 2 weeks

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20
Q

Erythema multiforme usually affects what areas

A

palms, soles, feet

dorsal surfaces of the distal extremities

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21
Q

Management of erythema multiforme

A

Mostly due to infection so treat underlying infection

  • antivirals if HSV
  • antibiotics (macrolide - clarithromycin etc or doxycycline) if mycoplasma pneumonia

Treat symptoms

22
Q

Characteristic clinical feature of erythema multiforme

A

Target lesions (bull’s eye lesion) - central vesicle surrounded by an often haemorrhagic maculopapule

23
Q

Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are more severe forms of what other acute skin disease

A

erythema multiforme

24
Q

Describe Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

  • onset after drug exposure
  • biochemical findings
A

2-8 weeks

High eosinophils
Abnormal liver function

25
Q

Clinical features of Eosinophilia and Systemic Symptoms (DRESS) (4)

A

Fever
Widespread rash
Lymphadenopathy
Visceral involvement (hepatitis, pneumonitis, myocarditis etc) is the major cause of morbidity and mortality in this syndrome

26
Q

Principles of management of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) (4)

A

Stop causative drug - antibiotics, anticonvulsants

Supportive treatment

  • dressings
  • analgesia
  • IV fluids

High dose steroids

Immunosuppressants

27
Q

What is pemphigus + pathophysiology

A

group of autoimmune blistering diseases that involve the epidermis, mucosa, or both

autoantibody binds to desmosomes which hold the keratinocytes of the skin and mucosa together

28
Q

Clinical features of pemphigus (5)

A

erosions/superficial blisters of skin, scalp, mucosal linings (of mouth, nose, eyes) - rupture easily

Chronic mouth erosions

Nikolsky’s sign

Itchy scalp

Painful skin

29
Q

Treatment of pemphigus

A

Oral/IV steroids

Immunosuppressants

30
Q

Investigations of pemphigus (2)

A

Skin biopsy + direct immunofluorescence staining
- shows immunoglobulin and C3 deposits on the keratinocyte surface

Skin biopsy + Hematoxylin and eosin (H&E) stain
-histology reveals keratinocyte acantholysis

31
Q

What is pemphigoid (different from pemphigus)

A

Autoimmune blistering disease characterised by auto-antibodies against hemidesmosomal antigens (derma-epidermal junction)

32
Q

Difference between pemphigus and pemphigoid (both autoimmune blistering conditions that affect skin and may or may not involve mucosa membranes)

  • common/uncommon
  • age group found in
  • blister characteristics
  • involvement of mucosa membranes
  • systemic wellness
A

Pemphigus

  • uncommon
  • middle aged
  • blisters FRAGILE, NOT INTACT, easily RUPTURE
  • mucous membranes usually affected - mouth, eyes
  • can be very unwell if advanced

Pemphigoid

  • common
  • elderly
  • blisters intact, firm, tense; more itchy than pemphigus
  • even if advanced, usually fairly well systemically
33
Q

Treatment of pemphigoid (2)

A

Topical steroids if lesions localised

Oral steroids if widepsreas

34
Q

Common causes of erythrodermic psoriais and pustular psoriasis (severe acute unstable forms of psoriasis) (2)

A

Sudden withdrawal of oral steroids or potent topical steroids in patient with known psoriasis

Infection

35
Q

Severe acute/emergency forms of psoriasis

A

Erythrodermic psoriais

Pustular psoriasis

36
Q

Clinical features of generalised pustular psoriasis (4)

A

Generalised erythema (large patches of it)

Clusters of pustules - at flexures, genitalia

Fever/malaise

Painful itchy skin

37
Q

Treatment of

  • generalised pustular psoriasis (1)
  • erythrodermic psoriasis (1 or 1)

(unstable emergency forms of psoriasis)

A

Oral retina - acitretin

Immunosuppressants - ciclosporin
OR
Biologics (TNF-alpha inhibitors) - infliximab

38
Q

What is eczema herpticum (emergency form of eczema) + cause

A

extensive cutaneous vesicular eruption that arises from pre-existing skin disease, usually atopic dermatitis/eczema

HSV 1 infection on a background of poorly controlled eczema

39
Q

Clinical features of eczema herpticum (3)

A

Fever/chills

MONOMORPHIC/ clusters of red painful, itchy vesicles

Punched out erosions - when the vesicles burst

Lymphadenopathy

40
Q

Treatment of eczema herpticum (2)

A

Topical steroid

Treat viral infection - aciclovir

41
Q

Staphylococcal scalded skin syndrome more common in who

A

Children

immunosuppressed adults or those who have kidney failure

42
Q

What is staphylococcal scalded skin syndrome + cause

A

Widespread erythematous painful rash caused by staph aureus

43
Q

Clinical features of staphylococcal scalded skin syndrome (5)

A 
Diffuse erythematous rash
Tender painful skin
Vesicles/blisters
Fever
Desquamation - peeling of epidermis
44
Q

Treatment of staphylococcal scalded skin syndrome (2)

A

IV antibiotics

Supportive therapy

  • cleansing
  • emollient
  • analgesia
45
Q

What is urticaria + symptoms

A

when a trigger causes high levels of histamine release in skin –> dilated leaky vessels

aka hives
- outbreak of ITCHY swollen, pale red bumps/plaques (wheals) on the skin that appear suddenly – either as a reaction to certain allergens, or idiopathic

46
Q

Causes of acute urticaria (<6 weeks) (4)

A

Idiopathic - most common
Infection
Drug allergy - uncommon
Food allergy - uncommon

47
Q

Treatment of acute urticaria (2)

A

Antihistamine

Steroids - only if severe

48
Q

Causes of chronic urticaria (>6 weeks) (3)

A

Autoimmune/idiopathic
Physical trauma
Vasculitic

49
Q

Treatment of chronic urticaria (3)

A

Antihistamines

then

Antileukotrienes

then

Monoclonal antibodies to IgE - omalizumab (immunomodulant)

50
Q

Regardless of all the different types of acute dermatological emergencies, what are 4 basic principles applied to all

A

Good fluid and electrolyte balance
Temperature regulation
Emollients (moisturise)
Anticipate and treat infection

51
Q

What is bullous pemphigoid

  • what skin layers are involved
  • what type of hypersensitivity reaction
A

autoimmune pruritic skin disease that involves the formation of bullae at the space between the epidermis and dermis

It is classified as a type II hypersensitivity reaction, with the formation of anti-hemidesmosome antibodies

Year 2 - Dermatology (10 decks)

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