Acute + emergency Flashcards
Consequence of the loss of the mechanical barrier function against infection of the skin
sepsis
Consequence of loss of temp regulation function of skin
Hypo/hyperthermia
Consequences of the loss of fluid and electrolyte balance function of the skin
Protein and fluid loss
Renal impairment
Peripheral vasodilation
What is erythroderma
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
Name some acute/emergency dermatological conditions
Erythroderma
Drug reactions
-Stevens-Johnson syndrome / toxic epidermal necrolysis spectrum
Extensive blistering conditions
Generalised pustular psoriasis
Eczema herpeticum
Causes of erythroderma (reddening/erythema of the skin due to inflammatory skin disease; affecting at least 90% of the body surface area)
Psoriasis - commonest
Eczema
Drug induced - e.g. vancomycin
What skin syndrome can excessive vancomycin cause
Red man syndrome
Principles of management of erythroderma (9)
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
Name 4 severe drug induced reactions of the skin
Erythroderma
Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN)
DRESS
What is Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN)
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
Stevens Johnson Syndrome (SJS) /Toxic epidermal necrolysis (TEN) are secondary to use of what drug types (3)
Anticonvulsants
Antibiotics
NSAIDs
Difference between Syndrome (SJS) and Toxic epidermal necrolysis (TEN)
SJS has <10% total body surface area
TEN has >30% TBSA involvement
Symptoms (2) /signs (4) of Syndrome (SJS) and Toxic epidermal necrolysis (TEN)
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
Diagnosis of Syndrome (SJS) and Toxic epidermal necrolysis (TEN) based on what
clinical presentation + confirmed with skin biopsy
Describe the characteristics of the rash in Syndrome (SJS)/ Toxic epidermal necrolysis (TEN)
May start as macular lesions (small/red/flat)
May get blistering
May get flat atypical target lesions
Principles of management of Syndrome (SJS) and Toxic epidermal necrolysis (TEN) (2)
Stop the offending drug
Supportive therapy
- dressings
- topical antibiotics
- emollients
- eye care
- analgesia
- IV fluids for hydration
+/- high dose corticosteroids
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
Low - 0-2
High - 3-5;
-5 = >90% mortality
Why should all patients manifesting signs and symptoms of SJS/TEN have an ophthalmological consultation upon admission
as can get erosion/ulceration of eye so need to preserve vision and reduce complications
What’s erythema multiforme + describe the onset period
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
Erythema multiforme usually affects what areas
palms, soles, feet
dorsal surfaces of the distal extremities
Management of erythema multiforme
Mostly due to infection so treat underlying infection
- antivirals if HSV
- antibiotics (macrolide - clarithromycin etc or doxycycline) if mycoplasma pneumonia
Treat symptoms
Characteristic clinical feature of erythema multiforme
Target lesions (bull’s eye lesion) - central vesicle surrounded by an often haemorrhagic maculopapule
Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are more severe forms of what other acute skin disease
erythema multiforme
Describe Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- onset after drug exposure
- biochemical findings
2-8 weeks
High eosinophils
Abnormal liver function
