Acute & Emergency Dermatology

Question 1

What is erythroderma?

Answer 1

Inflammatory skin diseases affecting >90% of the total skin surface

Question 2

What are the casuses of erythroderma?

Answer 2

Psoriasis
Eczema
Drugs
Cutaneous lymphoma

Question 3

When do drug reactions usually take place?

Answer 3

1-2 weeks afterwards

Question 4

What is morbilliform exanthem?

Answer 4

Measles like spots all over body as mild reaction

Question 5

What are the severe drug reaction manifestations?

Answer 5

Erythroderma
Stevens Johnson Syndrome
Toxic epidermal necrolysis
DRESS

Question 6

What is the prevalence of SJS/TEN?

Answer 6

SJS - 1-2/million

TEN - 0.4-1.2/million

Question 7

SJS/TEN is secondary to what?

Answer 7

AntiB
Anticonvulsants
Allopurinol
NSAIDs

Question 8

How does detachment of the epidermis present in SJS?

Answer 8

Patches all over body

Question 9

How does detachment of the epidermis present in TEN?

Answer 9

Huge patch upper arms, chest

Question 10

How does SJS present?

Answer 10

Fever, Malaise, Arthralgia
Rash
Mouth ulceration
Ulceration of other mucus membranes

Question 11

How does the rash present in SJS?

Answer 11

Maculopapular
Target lesions
Blisters
Erosions <10% body

Question 12

How does the mouth ulceration present in SJS?

Answer 12

Greyish/white membrane

Haemorrhagic crusting

Question 13

How does toxic epidermal necrolysis present?

Answer 13

Prodromal febrile illness
Ulceration of mucus membranes
Rash

Question 14

How does the rash present in toxic epidermal necrolysis?

Answer 14

Macular, purpuric or blistering
Sloughing desquamation >30% skin
Nikolsky sign may be positive

Question 15

How is SJS/TEN managed?

Answer 15

Identify and stop culprit drug
?Steroids
?IV Immunoglobulins
?anti-TNF therapy
?Ciclosporin

Question 16

How is mortality scored in TEN/SJS?

Answer 16

SCORTEN
Age > 40
Malignancy 
HR > 120
> 10% detachment
Urea > 10
Glucose > 14
Bicarbonate < 20
SJS 10%
TEN 30%

Question 17

What long term complications is associated with TEN/SJS?

Answer 17

Pigment skin changes
Scarring
Eye disease blindness
Nail and hair loss
Joint contractures

Question 18

What is Erythema Multiforme?

Answer 18

Hypersensitivity triggered by infection

HSV, Mycoplasma pneumonia

Question 19

How does Erythema multiforme present?

Answer 19

Abrupt onset 100s of lesions in 24hrs
Distal -> proximal
Palms and soles
Mucosa 
Evolve macules - blisters

Question 20

How is erythema multiforme managed?

Answer 20

Self limiting over 2 weeks

Treat symptomatically and cause

Question 21

What is DRESS syndrome?

Answer 21

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Question 22

What is the prevalence of DRESS?

Answer 22

1:1/10,000

Question 23

What is the mortality of DRESS?

Answer 23

10%

Question 24

How does DRESS present?

Answer 24

Onset 2-8 weeks post exposure
Fever and widepread rash
Eosinophilia, deranged LFTs
Lymphadenopathy

Question 25

How is DRESS managed?

Answer 25

Stop drug Symptomatic and supportive Systematic steroids Immunosuppression or Ig

Question 26

What is Pemphigus?

Answer 26

Antibodies targeted at desmosomes Flaccid blisters rupturing easily Face, axillae, groin Nikolsky's sign may be +ve

Question 27

What is Nikolsky's sign?

Answer 27

Epidermis sloughing off with friction

Question 28

Nikolsky's sign is positive in what?

Answer 28

TEN/SJS | ~Pemphigus

Question 29

How does pemphigus present?

Answer 29

Mucus membranes Ill defined erosions in mouth Opened/easily rupturing blisters

Question 30

What is pemphigoid?

Answer 30

Antibodies directed at dermo-epidermal junction Intact epidermis forms roof of blisters Blisters usually tense and intact

Question 31

How is pemphigus treated?

Answer 31

Systemic steroids Dress erosions Supportive Methotrexate

Question 32

How is pemphigoid treated?

Answer 32

Topical steroids Systemic if diffuse Methotrexate

Question 33

How does pemphigoid differ from pemphigus?

Answer 33

Pemphigoid Common Elderly patients Intact blisters ``` Pemphigus Uncommon Middle aged Blisters fragile Mucus membranes involved ```

Question 34

What are the common causes of erythrodermic/pustular psoriasis?

Answer 34

Infection | Sudden withdrawal of oral steroids/potent topical steroids

Question 35

How does erythrodermic/pustular psoriasis present?

Answer 35

``` Rapidly developing: Erythema Clusters of pustules Fever ↑ WCC ```

Question 36

How is erythrodermic/pustular psoriasis managed?

Answer 36

Exclude infection Bland emollient Avoid steroids May require systemic therapy

Question 37

What is Eczema Herpeticum?

Answer 37

Disseminated herpes virus with a background of poorly controlled eczema

Question 38

How does Eczema Herpeticum present?

Answer 38

``` Monomorphic blisters "Punched out" erosions Painful, not itchy Fever Lethargy ```

Question 39

How is Eczema Herpeticum treated?

Answer 39

``` Aciclovir Mild topical steroid Treat infection Ophthalmology if eyes involved Consider immunocompromised ```

Question 40

What is Staphylococcal Scalded Skin Syndrome?

Answer 40

Common in children Immunocompromised adults Staph infection

Question 41

How does Staphylococcal Scalded Skin Syndrome present?

Answer 41

``` Diffuse erythematous rash Skin tenderness Blistering and Desquamation More prominent in flexures Fever Irritability ```

Question 42

How is Staphylococcal Scalded Skin Syndrome managed?

Answer 42

IV AntiB | Supportive care

Question 43

How does staph cause Staphylococcal Scalded Skin Syndrome?

Answer 43

Staphylococcus produces toxin which targets Desmoglein 1

Question 44

How does a Hive present?

Answer 44

Central swelling of variable size Surrounded by erythema Itching/burning Fleeting

Question 45

How does angioedema present?

Answer 45

Deep swlling of skin or mucous membranes

Question 46

What is the typical cause of acute urticaria?

Answer 46

Idiopathic Infection (usually viral) Drugs (IgE) Food (IgeE)

Question 47

How is acute urticaria treated?

Answer 47

Oral antihistamine Short course of oral steroid Avoid opiates and NSAIDs

Question 48

What is the typical cause of chronic urticaria?

Answer 48

Autoimmune/idiopathic Physical Vasculitic Type 1 hypersensitivity

Question 49

What is the first line of chronic urticaria management?

Answer 49

Non-sedating H1 antihistamine

Question 50

What is the 2nd line of chronic urticaria management after antihistamine?

Answer 50

Higher dose up to 4 times dose or second antihistamine

Question 51

What is the 3rd line of chronic urticaria management after | increased antihistamine?

Answer 51

Second line agent Anti-leukotriene Angioedema - transexamic acid

Question 52

What is the 4th line therapy for chronic urticaria?

Answer 52

Immunomodulant | Omalizumab

Question 53

Why are blisters usually intact in pemphigoid?

Answer 53

The blisters are deeper

Question 54

How is pustular psoriasis characterised?

Answer 54

Pustules are sterile

Question 55

How does Eczema herpeticum differ from Eczema?

Answer 55

Eczema herpeticum patients are systematically unwell

Question 56

What must be considered in an adult with Eczema herpeticum?

Answer 56

Do they have a history of eczema Could they be immunocompromised WCC HIV