Dermatological Emergencies

Question 1

Drugs associated with maculopapular drug eruptions

Answer 1

• Antibiotics
• Anti-seizure medication

Question 2

Course of maculopapular drug eruption

Answer 2

• Red maculopapular rash with generalized distribution that spares the face
• Often itchy, may involve fever
• Onset 4-21 days after starting drug, lasts 1-3 weeks
• Topical steroids and oral antihistamines for symptom releif

Question 3

Erythema multiforme

Answer 3

Relativley common, acute, often recurrent inflammatory disease

• Etiology unknown but commonly associate with preceding infections, especially HSV
• Typical presentation involves red maculopapules appearing suddenly in symmetric pattern on backs of hands and feet and extensor surfaces of forearms and legs
  
  • Commonly mucosal lesions (lips and buccal mucosa)
  • Evolve into target lesions with central vesicle
• Entire episode can last around 1 month

Question 4

Exfoliative erythroderma

Answer 4

Serious (life threatening) reaction pattern on skin characterized by redness, infiltration, and scaling of almost the entire surface of the skin

• Acute and chronic forms
• Issue can be high output cardiac failure
• Usually in individuals over 50
• Isolation and supportive therapy

Question 5

Steven-Johnson Syndrome (SJS) vs Toxic Epidermal Necrolysis (TEN)

Answer 5

Different regions of a single spectrum of disease that are acute, life-threatening mucocutaneous reactions characterized by extensive epidermal necrosis and epidermal detachment

• Widespread apoptosis of keratinocytes
• Often accompanied by fever, tachycardia, renal issues, and sloughing of GI lining
• SJS is less than 10% epidermal detachment
• TEN is more than 30% epidermal detachment
• Both are often results of drug reactions

Question 6

Pemphigus vulgaris

Answer 6

Chronic blistering disease that involves destruction of desmosomes

Lesions in mouth and on scalp, face, head, and neck

Question 7

Pemphigus foliaceus

Answer 7

Autoimmune blistering disease

• Scaly, crusty erosions on eythemetous base
• Initially presents on face and trunk and then spreads to large areas of body

Question 8

Pemphigus

Answer 8

Autoantibodies bind to calcium-dependent adhesion molecules (desmogleins)

• Can treat with systemic glucocorticoids

Question 9

Bullous pemphigoid

Answer 9

Large bullous lesions (blisters) on skin (generally lower abdomen/groin/flexural areas)

• Lesions eventually burst and are replaced by erosions with or without crust
• Elderly are most suceptible
• Due to autoantibody attack of hemidesmosomes
• Treat with glucocorticoids

Question 10

Necrotizing fasciitis

Answer 10

Characterized by rapid progression of infection with extensive necrosis of soft tissues and overlying skin

• Often from group A strep +/- anaerobes +/- gram-negative bacilli
• Severe sepsis/fever
• Clinical manifestations appear 36-72 hours after onset