Derm emergency

Question 1

Urticaria:

• Definition
• Causes of acute
• Causes of chronic
• Symptoms
• Investigations
• Management

Question 2

Staph scalded skin syndrome:

• Definition
• Symptoms
• Signs
• Investigations
• Management
• Complications

Answer 2

Staph scalded skin syndrome:

• Definition: aures produces toxins which break down the proteins holding skin together - common in <5 bc no immunity yet + kidneys can’t excrete toxins
• Symptoms : erythema patches -> bullae -> burst, fever, dehydrated
• Signs: nikolskys sign
• Investigations: swab, cultures
• Management: iv erythromycin, fluids, emollients, 1 week
• Complications: spesis, renal failure

Question 3

Drug reactions:

• Definition
• Common drugs
• Symptoms
• Investigations
• Management

Question 4

Necrotising fasciitis:

• Definition
• Risk factors
• Symptoms
• Signs
• Investigations
• Management

Answer 4

Necrotising fasciitis:

• Definition: soft tissue infection of deep fascial planes + subcut tissue causing necrosis - strep pyogenes. or most commonly due to mixed anaerobes (diabetics)
• Risk factors: injury, alc, malnutrition, iv drugs, gliflozins
• Symptoms: extreme pain, blistering, necrosis, haem unstable
• Signs: crepitus, oedema, pus only when putting finger in, gas gangrene
• Investigations: lactate, coag, via blood gas, cultures
• Management : debridement, abx

Question 5

Blistering disorders:

• Bullous pemphigoid
• Pemphigus vulgaris

Answer 5

Blistering disorders:

• Bullous pemphigoid: autoab against epidermis + dermis. In older, itchy and tense blisters. Needs dressing, steroids, tetracycline + nicotinamide. Skin biopsy shows igG + C3 at dermoepidermal junction
• Pemphigus vulgaris: autoab in epidermis. in younger/jewish, flaccid blisters, musocal involvement. Needs dressing, oral hygeine, oral steroids. Biopsy shows acantholysis

Question 6

Stevens Johnson syndrome:

• Definition
• Symptoms

Answer 6

Stevens Johnson syndrome:

• Definition: same as TEN but <10% body SA
• Symptoms: maculopap rash, nikolskys sign, mucosal involvement, fever, arthralgia

Question 7

Toxic epidermal necrolysis TEN:

• Definition
• Symptoms
• Investigations
• Causes
• Management
• Complications

Answer 7

Toxic epidermal necrolysis TEN:

• Definition : extensive skin necrosis
• Symptoms: fever/sore throat/itch then maculopapular rash then blistering and peeling of skin, + nikolskys
• Investigations: on biopsy full thickness epidermal necrosis with subepidermal detachment
• Causes: drugs (penicillin, carbamezapine, sulfonamides, allopur, nsaids, phenytoin), infection (hsv, mycop)
• Management: supportive fluids, iv IG, nutrition, analgesia, ophthal review, ciclosporin
• Complications: hypothermia, electrolyte imbalance, sepsis, AKI

Question 8

Erythema nodosum:

• definition
• Causes
• Symptoms
• Management

Answer 8

Erythema nodosum:

• def: hypersens response to stimuli causing inflamm of subcut fat
• Causes: NODOSUM: NO-idiopathic, Drugs (penicillin, sulphonamides), Oral cocp/preg, Sarcoidosis/tb, Uc/crohns, Micro (strep, mycoplasma, ebv, gastroent)
• Symptoms: red lumps on shins, painful, turn into bruises
• Management: rest, analgesia, steroids, takes up to 6 weeks

Question 9

Erythema multiforme:

• Definition
• Symptoms
• Management

Answer 9

Erythema multiforme:

• Definition: hypersens reaction especially to hsv, meds (penicillins/carbamez/allopur/nsaids/cocp), or mycoplasma pneum
• Symptoms: rapid onset 48 hours widespread non itchy rash with target lesions
• Management: self limiting 2 weeks, if major involvement (mucosa)

Question 10

Erythroderma:

• Definition
• Causes
• Symptoms
• Management
• Complications

Answer 10

Erythroderma:

• Definition: exfoliative dermatitis 90% SA
• Causes: psoriasis/eczema, lymphoma, drugs (sulfonamides, gold, sulfonylurea)
• Symptoms : oedematous skin NOT PEELING, unwell, lymphad
• Management : emollients, wet wraps, steroids topical
• Complications: hypothermia, electrolyte imbalance, HF

Question 11

Eczema herpeticum:

• Definition + causes
• Symptoms
• Investigations
• Management
• Complications

Answer 11

Eczema herpeticum:

• Definition + causes: viral skin infection due to hsv1 (or cocksackie)
• Symptoms: rapid onset widespread vesicular rash itchy + pus and once burst leaves punched out ulcers, fever, lymphad, bowel changes
• Investigations: swabs
• Management: iv aciclovir
• Complications: sepsis, dic, bact infection, encephalitis, blind

Question 12

Dermatofibroma:
- definition
- symptoms

Answer 12

Dermatofibroma:
- definition: histiocytomas, benign fibrous skin lesions. caused by abnormal growth dermal dendritic histiocyte cells often following injury
- symptoms: solitary papule/nodular, skin dimples when pinching the lesion

Question 13

Sebhorrhoeic keratoses:
- definition
- symptoms
- mx

Answer 13

Sebhorrhoeic keratoses:
- definition: benign epidermal skin lesion in older people
- symptoms: flesh -> brown, stuck on appearance, dry
- mx: curettage, cryosurgery, shave biopsy