Dermatological Emergencies

Question 1

What are causes of SJS/TEN?

Answer 1

Sulfonamide abx- sulfalazine or co-trimoxazole
Penicillins
AEDs- lamotrigine, carbmazepine, phenytoin
Allopurinol
COCP
NSAIDs

Question 2

What are clinical features of SJS/TEN?

Answer 2

Prodrome of flu symptoms

Rash begins as macular with target lesions typically on upper torso and spreads rapidly to arms/legs/face

Blisters develop which burst and exposed sores are painful
Subsquently desquamation of layers of skin (Nikolsky sign positive- gentle lubbing on skin causes desquamation)
Mucosal involvement- oral ulceration, lip involvement
Pruritis is not uncommon
Eye involvement e.g. eye pain, conjunctivitis

Question 3

How do you differentiate between SJS and TEN?

Answer 3

Proportion of skin affected

SJS <10%
TEN >30%

In the middle is a combination of the 2

Question 4

What is the management of SJS/TEN?

Answer 4

Stop causative medications
IV fluids
Generous creams/dressings to maintain moisture

IVIG commonly used first line

Can consider immunosuppressive agents

Question 5

What is Drug Hypersensitivity Syndrome (DRESS)?

Answer 5

Severe, cutaneous and system reaction to a new medication
T cell mediated reaction

Question 6

What are symptoms of DRESS?

Answer 6

Symptoms usually begin >2 weeks after commencing AED, Allopurinol

Triad of
1) Pyrexia >38
2) Extensive rash- normally morbilliform can lead to skin shedding
3) Organ involvement e.g. hepatitis most common

Question 7

What will be found on examination of DRESS?

Answer 7

Bloods
-Eosinophilia, leukocytosis, thrombocytopenia, anaemia

Lymphadenopathy
Mucosal involvement in 1/3 of patients

Question 8

What are causative drugs of DRESS?

Answer 8

AEDs- carbmazepine, phenobarbital, phenytoin
Allopurinol
Olanzapine
Sulfonamide abxH

Question 9

How is DRESS diagnosed and managed?

Answer 9

Diagnosed via skin biopsy

Treatment
- stop causative agent
- steroids- prednisolone
- supportive treatment, emollients, antihistamines

Question 10

What is Erythroderma?

Answer 10

A rash that involves at least 90% of skin surface area
Commonly occurs secondary to an exacerbation of chronic skin disease such as psoriasis

Question 11

What are features of erythroderma?

Answer 11

Widespread erythematous, pruritic rash on >90% body
Systemically unwell
History of chronic skin disease
May have signs of desquamation

Question 12

What is the management of erythroderma?

Answer 12

Emollients, creams, wet dressing
Consider topical steroids
Replace fluids/electrolytes

Question 13

What is eczema herpeticum?

Answer 13

HSV 1 or 2 infection of the skin on background of eczema
Usually occurs in children/ those with severe eczema

Question 14

What are clinical features of eczema herpeticum?

Answer 14

Rapidly progressing painful rash in patients with history of eczema
Lesions are itchy and painful

Monomorphic punched out erosions, blisters, crusted papules

Question 15

What is the diagnosis and management of eczema herpeticum?

Answer 15

Clinical =/- swabs

Management
- Admit for IV aciclovir
- opthalmology review if eye involvement