Blistering Rashes

Question 1

Causes

Answer 1

Sunburn
Herpes simplex
eczema herpeticum
herpes zoster
hand foot & mouth
Kawasaki syndrome
folliculitis
bullous impetigo
Staphylococcal scalded skin
Trauma
Bites
Allergic contact dermatitis
Erythema multiforme
Stevens johnsons Syndrome
Toxic epidermal necrolysis
Pemphigoid
Pemphigus

Question 2

Herpes

Answer 2

crops of vesicles
defined anatomical area
painful

Ix: tsanck smear
Mx: aciclovir/ valaciclovir
analgesia

Question 3

Eczema herpeticum

Answer 3

Primary herpes infection with active dermatitis

Question 4

Folliculitis

Answer 4

superficial inflammation of hair
Staph aureus
Skin: 1-5 mm yello grey papules/ pustules
\+/- pruritic/ painful
Mx: 
antiseptics
Antibiotic severe dz

Question 5

Impetigo

Answer 5

honey colored crusts: face/ elbows/ knees
Bulous impetigo: staph
Non bullous: smaller lesions staph or strep

Question 6

Erythema Multiforme: least severe of immunological blisters

Answer 6

Males & younger
Hypersensitivity reaction to:
-Herpes simplex
-mycoplasma
-penicillins/ cephalosporin
-sulphonamides
-phenytoin
-carbamazepine
-allopurinol
-lamotrigine
-NSAIDS
-immunisation
malignancy: lymphoma/ leukaemia
Infections
-TB
-Viral: herpetic, EBV, CMV
-bacterial- mycoplasma
collagen vascular dz

Question 7

Erythema Multiforme: Assessment

Answer 7

prodrome: mailaise/ fever
onset rash over few days
forms
-macules
-papules
-wheals
-vesicles
-bullae
Target lesions: diagnostic
-discrete initially
-coalesce advanced disease
Distribution
- hands/ feet/ forearms
Mucosa
-oropharyngeal/ lip crusting vesicles
Urticaria
Systemic
-fever
-arthralgia

Question 8

Erythema Multiforme: management

Answer 8

remove offending agen

supportive

Question 9

Steven Johnson Syndrome= erythema multiforme major

Answer 9

severe illness wide spread rash
< 10% BSA
> 1 mucous membrane involved
oral lesion- painful ulcers

Question 10

SJS: Management

Answer 10

Supportive
Burns care
topical betamethaosn cream
avoid steroids

Question 11

Toxic Epidermal Necrolysis

Answer 11

Causes:
Drugs
HIV
Immunosuppression
lymphoma
leukaemia

Question 12

TENS clinical features

Answer 12

Full thickness epidermal necrosis
> 30% BSA
Severe illness
high mortality
prodromal
widespread erythema/ blistering
bullae that rapidly desquamate
Mucousmembranes involved

Question 13

TENS: Mx

Answer 13

IV immunoglobulin
Ciclosporin
Burns Mx
ICU

Question 14

Toxic Shock Syndrome

Answer 14

Colonisation with staph aureus
clinical
-desquamating erythroderma
-shock
-multiorgan failure
-Non focal CNS dysfunction
-vaginitis
-pharyngitis
-conjunctivitis

Question 15

Staphylococcal Scalded skin

Answer 15

common infants
Staph infection
-caused by epidermolytic toxin
Clinical
-fever
-tender erythematous skin
-bullae + exfoliation
-nikolsky +
= skin failure
Rx
-fluclox
-look for focus
-handle skin carefully

Question 16

Allergic contact dermatitis

Answer 16

Type IV hypersensitivity reaction
Clinical:
-contact patterns
-very itchy
-erythema
-vesicular & bullous

Question 17

Bullous Pemphigoid

Answer 17

Chronic blistering dz onset days to weeks
elderly
Clinical
-blistering: erythematous skin, skarts as urticarial plaques
-blisters: tense roof/ itchy/ ? extensive
-nikolskys NEGATIVE
-Mucous membran uncommon
Mx:
Prednisone
azathioprine

Question 18

Pemphigus

Answer 18

antibodies to keratinocyte adhesion molecules
Clinical:
-intraepidermal bullae
-intertrigenous areas involved
-easily ruptured bullae in normal skin
-exfoliation
-MM often involved
-Nikolskys positive