Acute & Emergency Dermatology Flashcards
What are the types of skin drug reactions? [10]
- Maculopapular
- Urticaria
- Morbilliform
- Papulosquamous
- Phototoxic
- Pustular
- Lichenoid
- Fixed drug rash
- Bullous
- Itch (no rash)
What are the common drugs that cause acute drug rashes? [6]
- Antibiotics i.e. penicillins, trimethoprim
- NSAIDs
- Chemotherapeutic agents
- Psychotropic chlorpromazine
- Anti-epileptic lamotrigine, carbamazepine
- Cardiac drugs:
- Beta-blockers,
- ACE inhibitors,
- Anticoagulants
Name the blistering disorders that are drug/infection induced [2]
- Steven Johnson Syndrome
- Toxic epidermal necrolysis
Name the immunobullous blistering disorders [2]
- Bullous pemphigoid
- Bullous pemphigus
Describe Stevens Johnson Syndrome under the following headings:
- what is it? [1]
- pathogenesis? [2]
- causes? [4]
- Blistering disorder that is essential a (less severe) form of toxic epidermal necrolysis (TEN)
- Pathogenesis:
- Cell death causes the epidermis to separate from the dermis
- Hypersensitivity complex that affects the skin & mucous membranes
- Causes
- Certain medications (Iamotrigine)
- Antibiotics
- Infection
- Cancers
Describe Toxic Epidermal Necrolysis (TEN) under the following headings:
- what is it?
- pathogenesis & complications? [3]
- causes? [1]
- how to differentiate from Stevens Johnson Syndrome? [1]
- severity determined by…? [1]
- management? [4]
- Blistering disorder which is a dermatological emergency
- Pathogenesis:
- Causes the epidermis to DETACH from the dermis all over the body
- Leaves body susceptible to severe infection
- Death is usually as a result of sepsis & subsequent multiorgan system failure
- Causes:
- Majority are drug induced
- If <10% skin involvement, think Stevens Johnson Syndrome
- Severity determined by SCORTEN scale
- Management
- STOP suspect drug
- Supportive medication
- Dressings
- RARELY immunosuppression
Describe erythema multiforme under the following headings:
- what is it? [1]
- causes? [3]
- treatment? [1]
- Self-limiting allergic reaction with no or mild prodrome
- Causes:
- HSV,
- EBV,
- Occasionally drug induced
- Target lesions
What are the types of immunobullous disorders? [5]
- Bullous pemphigoid
- Mucous membrane pemphigoid
- Paraneoplastic pemphigoid
- Pemphigus (e.g. Pemphigus vulgaris)
- Dermatitis herpetiformis (coeliac disease)
How do you diagnose an immunobullous disorder? [2]
Skin biopsy with immunofluorescence
How do you treat/manage immunobullous disorders? [6]
- Reduce autoimmune reaction → topical/oral corticosteroids
- Steroid sparing agents
- i.e. azathioprine, anti-inflammatory tetracyclines
- Burst any blisters
- Dressings and infection control
- Check for oral/mucosal involvement
- Consider screen for underlying malignancy
What specific treatment is used for dermatitis herpetiformis (e.g. with coeliac disease)? [3]
- Topical steroids
- Gluten free diet
- Oral dapsone
Describe the clinical features of urticaria under the following headings:
- what is it? [1]
- acute causes? [4]
- chronic causes? [6]
- treatment? [4]
- Itchy wheals (Hives) Lesions that last <24 hours & are non-scarring
- Acute (<6 weeks) causes:
- Viral infections
- Medication (NSAIDs, aspirin, ACE)
- Parasitic infections
- Foods & food additives
- Chronic (>6 weeks) causes:
- Immune-mediated type 1 allergic IgE response
- Non-immune-mediated direct mast cell degranulation releasing histamine
- Caused by: opiates, antibiotics, contrast media & NSAIDs
- Treatment
- Antihistamines
- Steroids
- Immunosuppression - methotrexate
- Omiluzimab – dampens down autoimmune interaction
What are the causes of erythroderma? [4]
- Psoriasis
- Eczema
- Drug reaction
- Cutaneous lymphoma
How do you treat erythroderma? [3]
- treat underlying skin disorder,
- supportive treatment
- fluid/temperature balance
