Dermatological emergencies Flashcards
What are some examples of dermatological emergencies?
- Erythema multiforme
- SCC
- Bullous pemphigoid
- Erythroderma
- Henoch shonlein purpura
- Measles
- Toxic epidermal necrolysis
What are the 2 classes of erythema multiforme?
Minor = Skin only
Major = Skin + Mucous membranes
What are some causes of erythroderma?
- Idiopathic
- Drugs (E.g. sulphonamides, penicillin, anti-malarials, anti-convulsants, allopurinol)
- Eczema
- Psoriasis
- Cutaneous T-cell lymphoma (Sezary syndrome)
- Pityriasis rubra pilaris
- Blistering (Pemphigus and bullous pemphigoid)
What investigations are required in erythroderma?
- Skin swabs
- Septic screen
- FBC and U&E
- HIV test
- Echocardiogram
- Skin biopsy
How is erythroderma managed?
- Admit
- Stop offending drug if necessary
- Emollients
- Mild to moderate potency topical steroids
- Manage fluid balance and temperature
- IV antibiotics if required
- Anti-histamines
- Skincare
- Treat according to cause (MTX for psoriasis)
What is erythroderma?
A severe inflammation of most of the bodies surface
What is toxic epidermal necrolysis?
A rare, acute, lifethreatening skin/mucous membrane reaction to usually a medication, characterised by epidermal death (Necrosis)
What is the precursor condition of toxic epidermal necrolysis?
Steven Johnson syndrome
What are the 3 stages of body surface desquamation?
- <10% = Steven Johnson Syndrome
- 10-30% = SJS/TEN overlap
- > 30% = Toxic epidermal necrolysis
What are some causes of toxic epidermal necrolysis?
Drugs (80%)
Infection
What are some drugs that can cause toxic epidermal necrolysis?
Allopurinol, Sulfasalazine, carbemazepine, lamotrigine, phenytoin, cephalosporins, NSAIDs, macrolides, omeprazole
What are some infections that can cause toxic epidermal necrolysis?
- Mycoplasma pneumoniae
- Herpes simplex
What are the stages of evolution of a rash in toxic epidermal necrolysis?
Prodrome
Prodromal rash
Necrotic epidermolysis
Full thickness epidermal detachment
What are the prodromal features of TEN?
Fever
Malaise
Arthralgia
Describe the features of the prodromal rash of TEN
Morbilliform, diffuse erythema, can be target like, rapid confluence of lesions
Describe the features of necrotic epidermolysis in TEN
Macular areas with a crinkled surface that enlarge and coalesc, then sheet like loss of epidermis, raised flaccid blisters, positive nikolsky sign
Describe the features of full thickness epidermal detachment in TEN
Red, fleshy dermis exposed, resembling a burn
What are some mucous membranes that can be involved in TEN?
Mouth, eyes, nasal, resp, GI, urethra, vagina
What are some investigations required in TEN?
- FBC (Neutropenia has poor prognosis)
- U+E (High urea and low bicarb has poor prognosis)
- Skin biopsy (Necrosis throughout epidermis and subepidermal split above basement membrane
How is TEN managed?
- Withdraw suspected drug
- Biopsy
- Meticulous skin care by ITU nurses
- IV fluids
- Analgesia
What are some supportive measures used in TEN?
- Avoid skin trauma with loss pressure mattresses
- Treat complicating infections
