DERM: dermatological emergencies Flashcards
what is Eczema Herpeticum?
Eczema herpeticum is a viral skin infection caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV).
which organism most commonly causes Eczema Herpeticum?
Herpes simplex virus 1 (HSV-1)
who does Eczema Herpeticum most commonly occur in?
in a patient with a pre-existing skin condition, such as atopic eczema or dermatitis, where the virus is able to enter the skin and cause an infection.
how does Eczema Herpeticum present?
A typical presentation is a patient who suffers with eczema that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake. There will usually be lymphadenopathy (swollen lymph nodes).
what is the management of Eczema Herpeticum?
- Admit
- Viral an bacterial swabs
- IV aciclovir 48 hours
- Treat 2o infection (IV antibiotics)
with reference to dermatological emergencies, what is DRESS?
Drug reaction with eosinophilia and systemic symptoms
- Severe reaction 2-8 weeks following drug initiation
- Widespread rash
- Multi-organ involvement
- lymphadenopathy
- Thrombocytopenia/ eosinophilia or deranged lymphocyte count
which drugs can cause DRESS (dermatological emergency)?
Antiepileptics
Sulphonamides
Allopurinol
how do you manage a drug eruption (dermatological emergency)?
- Accurate history
- Stop likely offending drug (cross reactivity so avoid related medications)
- Check FBC/ U&E/ LFT
- Supportive treatment: antihistamines, Emollients/ soap substitution, topical steroids.
- refer to dermatologist and. critical care.
with dermatological drug eruptions, what clinical features can you expect?
- Facial/ mucous membrane involvement
- Widespread erythema/ erythroderma
- Skin pain
- Blistering/ purpura/ necrosis
- Fever
- Lymphadenopathy/ arthralgia
- Deranged FBC/ LFT/ U&E
Shock
which type of dermatological drug eruption can present with Neutrophil leucocytosis?
Acute Generalised Exanthematous Pustulosis (AGEP)
what drugs commonly cause Acute Generalised Exanthematous Pustulosis (AGEP)?
- Tetracyclines
- Antifungals
- Calcium channel blockers
- Paracetamol
- Hydroxychloroquine
- Carbamazepine
which type of dermatological drug eruption can present with multi-organ involvement?
DRESS
what is Erythroderma?
- inflammatory skin disease affecting the entire skin surface
- often precedes or is associated with exfoliation when it may also be known as exfoliative dermatitis
what are some complications of Erythroderma?
- Secondary infection
- Loss of thermoregulation
- High output cardiac failure
- Fluid and electrolyte imbalance
- Hypoalbuminaemia
how does Erythroderma present?
- Pruritis
- Hair loss
- Hyperkeratosis palms/ soles
- Lymphadenopathy (‘dermatopathic’)
what are some causes of Erythroderma?
- Drugs
- Dermatitis (Atopic eczema, Contact dermatitis)
- Psoriasis
- Immunobullous disorders
- Pityriasis rubra pilaris (PRP)
- Cutaneous T-Cell Lymphoma
- Systemic malignancy
- HIV
how do you mange Erythroderma?
- Skin swab
- FBC, U&E, LFT, CRP
- Bland emollients
- Thermoregulation
- Fluid balance
- Antibiotics
- Antihistamine
- Refer to dermatologist (Skin biopsy, Consider systemic/ topical steroids)
what is Stevens Johnson Syndrome?
an immune response causes epidermal necrosis, resulting in blistering and shedding of the top layer of skin
what is Toxic Epidermal Necrolysis(TEN)?
more severe Stevens Johnson Syndrome
Generally, SJS affects less that 10% of body surface area whereas TEN affects more than 10% of body surface area.
what is Erythema Multiforme(EM)?
less severe Stevens Johnson Syndrome (minor)
- acute, self-limiting
- may be recurrent
- usually secondary to infection
what is the presentation of SJS/TEN?
- usually start with non-specific symptoms of fever, cough, sore throat, sore mouth, sore eyes and itchy skin.
- develop a purple or red rash that spreads across the skin and starts to blister.
- A few days after the blistering starts, the skin starts to break away and shed leaving the raw tissue underneath. Pain, erythema, blistering and shedding can also happen to the lips and mucous membranes. Eyes can become inflamed and ulcerated. It can also affect the urinary tract, lungs and internal organs.
what causes SJS/TEN?
Medications:
- Anti-epileptics
- Antibiotics
- Allopurinol
- NSAIDs
Infections:
- Herpes simplex
- Mycoplasma pneumonia
- Cytomegalovirus
- HIV
EM major/Steven Johnson/Toxic Epidermal Necrolysis have an association with which genes?
HLA genetic types
what are complications of SJS/TEN?
- Lack of thermoregulation
- Hypotension
- Reduced consciousness
- Oliguria and electrolyte imbalance
- Labile glucose readings
- Respiratory compromise
- Ocular problems
- Mucosal scarring
- Oesophageal stricturing/ GI involvement
- Pain
- Arthralgia
in SCORTEN the “Severity of illness score for TEN”, what is the criteria? (for TEN dermatological drug eruption)
- Age >40
- Malignancy
- Tachycardia >120
- Initial TBSA >10%
- Urea >10
- Glucose >14
- Bicarbonate >2
one point for each, bigger the score the higher the mortality, anything over. 5 is 90% mortality
what type of hypersensitivity reaction is Acute Urticaria?
type 1 hypersensitivity
what type of hypersensitivity reaction is Angioedema?
type 1 hypersensitivity
how does Urticaria present?
- also known as hives
- small itchy lumps that appear on the skin (wheals)
- patchy erythematous rash
- may be associated with angioedema and flushing of the skin
NB: may be associated with anaphylactic shock
what is Angioedema?
- Oedema of dermis and subcutaneous tissue
- With urticaria (40%) or alone (10%)
NB: may be associated with anaphylactic shock
what are the causes of Urticaria?
- Drugs (5%)
- Foods (3%)
- Contact reaction (eg latex, hairdye)
- Insect stings
- Infections
- Connective tissue diseases
- Internal malignancy
- C1 esterase inhibitor deficiency
- Idiopathic (up to 90% chronic urticaria)
what is the management of Urticaria?
- Anaphylaxis treatment if haemodynamic/ respiratory compromised.
- Identify & stop offending stimulus.
- Antihistamines.
- Systemic steroid (Prednisolone 5mg/kg 5 days then stop)
- Anti-pruritic emollients
- Refer to dermatologist
