Acute/Emergency Dermatology

Question 1

What is erythroderma and what can cause it? How is it treated?

Answer 1

Inflammation on >90% of skin
Psoriasis, eczema
Drugs
Cutaneous lymphoma
Hereditary

Consider ITU/burns
Removal of cause
Fluid balance and nutrition
Temperature regulation
Emollients, oral/eye care

Question 2

How does Stevens-Johnson syndrome present? What can cause it?

Answer 2

Fever, malaise, arthralgia
Maculopapular rash
Target lesions, blisters
Erosions <10% of surface

Cause by - antibiotics, anticonvulsants, allopurinol, NSAIDs

Question 3

How does Toxic epidermal necrolysis present?

Answer 3

Prodromal febrile illness
Mucous membrane ulceration
Macular/purpuric/blistering
Becomes confluent, sloughing (30% desquamation)
Causes are same as SJS

Question 4

What is erythema multiforme? What can cause it?

Answer 4

Abrupt onset of 100s of lesions over 24 hours
- distal > proximal
- palms and soles
- mucosal surfaces
Hypersensitivity, usually to infection
Usually self-limiting - symptomatic/causative treatment

Question 5

What is DRESS? What can cause it?

Answer 5

Drug rash with eosinophilia and systemic symptoms syndrome
Fever and widespread rash
Lymphadeonopathy
Up to 10% mortality
2-8 weeks after drug exposure
Symptomatic/causative treatment
Consider systemic steroids/immunosuppression

Question 6

What is the difference between pemphigus and pemphigoid? How are they treated?

Answer 6

Pemphigus blisters are fragile - not usually seen intact

• affects desmosomes
• systemic steroids, supportive therapies

Pemphigoid blisters usually intact

• affects dermo-epidermal junction
• topical steroids (systemic if diffuse)

Pemphigoid more common

Question 7

What are the features of erythrodermic/pustular psoriasis? What causes it and how is it treated?

Answer 7

Rapid generalised erythema +/- pustule clusters
Fever, elevated WCC

Can be caused by infection or sudden steroid withdrawal

Treat with bland emollient
AVOID steroids
Often requires systemic therapy

Question 8

How does eczema present? What causes it and how is it treated?

Answer 8

Monomorphic blisters and punched out erosions
- generally painful, not itchy
Fever and lethargy

Disseminated HSV on background of poorly controlled eczema
Treated with aciclovir
Mild topical steroid for eczema
Treat secondary infection

Question 9

What is staphylococcal scalded skin syndrome? How is it treated?

Answer 9

Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation follows
Fever and irritability

Can be caused by staph, immunocompromised

Requires admission
- IV antibiotics, supportive care

Question 10

How does urticaria present? What causes it and how is it treated?

Answer 10

Central swelling surrounded by erythema, dermal oedema
- itching, sometimes burning - histamine in dermis

Can be acute/chronic

• acute - idiopathic, viral, drugs/food
• • oral anti-histamine, short oral steroids, avoid opiates/NSAIDs
• chronic - autoimmune, idiopathic, physical, vasculitic, type I hypersensitivity (rarer)
• • non-sedating anti-H1, can add second or increase dose, also LTRA, tranexamic acid, immunomodulants (omazilumab, cyclosporin)