Derm Flashcards
What life-threatening skin conditions are you aware of?
Infective:
- necrotising fasciitis
- Toxic shock syndrome
Drug-related:
- SJS/Toxic epidermal necrolysis
- DRESS syndrome (drug, rash, eosinophilia and systemic symptoms syndrome)
Immune-mediated:
- Erythema multiform
- Pemphigus vulgaris
Inflammatory:
- acute generalised pustular psoriasis
- erythroderma (exfoliative dermatitis)
What is Stevens-Johnson syndrome and toxic epidermal necrolysis?
SJS and TEN are a spectrum of acute severe, life-threatening skin reactions characterised by:
- prodrome within 4-28 days of sore throat and fever
- rash (macules followed by blistering)
- mucocutaneous involvement and desquamation and necrosis
- organ dysfunction
What are the causes of SJS/TEN?
Drugs:
- sulphonamides and beta lactam abx
- allopurinol, NSAIDs, anticonvulsants
Infection:
- CMV
- mycoplasma
Graft vs host disease: - often severe and fatal
How are SJS and TEN differentiated?
SJS <10% TBSA
TEN/SJS overlap 10-30% TBSA
TEN >30% TBSA
What is the management of SJS TEN?
- Removal of precipitant
- supportive care (may develop MOF)- discuss with Burns centre
- topical antiseptics
- often IV steroids +/- IVIg +/- ciclosporin are used but not strong evidence of benefit
What is the mortality risk of SJS/TEN?
Up to 30% from drug related.
Mortality very high in GvHD.
What are the complications of SJS/TEN?
Septic shock
MOF
gastrointestinal perforation
renal failure
thromboembolic phenomena
What is DRESS syndrome?
Drug rash eosinophilia and systemic symptoms syndrome.
It is a severe life-threatening condition.
Caused by anticonvulsants and allopurinol most commonly.
Other causes include NSAIDS, antimicrobials and antivirals.
Characterised by a longer latency period of 2-6 weeks and the morbilliform rash.
Most common extracutaneous involvement is lymphatics, and liver.
Has a mortality of around 10%.
Mx includes:- removal of causative agent
- IV steroids
- supportive care
What are the causes of eosinophilia and rash?
CHINA
C - Connective tissue disease/Churg-strauss (EGPA)
H - Helminth infection
I - idiopathic
N - neoplastic (typically lymphoma)
A - Allergic reaction/Asthma