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SS: Dermatology > Dermatological Emergencies > Flashcards

Dermatological Emergencies Flashcards

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Dermatology Board Prep flashcards
1
Q

Conditions in Dermatological Emergencies

A 
Eczema herpeticum
Drug Eruptions
Erythroderma
Erythem Multiforme
Urticaria & angioedema
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2
Q

Eczema Herpeticum

A

Serious complication of Eczema caused by Herpes Simplex Virus

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3
Q

Presentation of Eczema Herpeticum

A

Extensive blisters, fever and malaise

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4
Q

Treating Eczema Herpeticum

A

IV Aciclovir and antibiotics

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5
Q

Complications of Eczema Herpeticum

A

Hepatitis
Encephalitis
Disseminated intravascular coagulation

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6
Q

Presentation of Drug eruptions

A

Facial involvement, widespread erythema, skin pain, blistering, purpura, necrosis, fever, lymphadenothpathy, arthralgia, shock

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7
Q

Type 1 Anaphylactic drug reactions

A

Anaphylaxis, urticaria, angioedema

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8
Q

Type 2 Cytotoxic drug reactions

A

Pemphigoid, Pemphigus, Thrombocytopenia

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9
Q

Type 3 Immune Complex Mediated drug reaction

A

Serum sickness, vasculitis

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10
Q

Type 4 Cell-mediated drug reaction

A

Contact allergy, DRESS, Morbilliform rash, TEN

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11
Q

Morbilliform

A

rash that looks like measles, 5-10 day onset, fever, malaise, maculopapula, symmetrical, can progress to erythroderma

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12
Q

Drugs causing Morbilliform

A 
Penicillin
Erthromycin
Carbamazepine
Allopurinol
NSAIDs
Phenytoin
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13
Q

Treating Morbilliform

A

Antihistamine
Emoillents/ Soap Substitution
Topical Steroid

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14
Q

Acute Generalised Exanthematous Pustulosis (AGEP)

A

Skin reaction with rapid onset, starting in face and flexures, fever, malaise, neutrophil leucocytosis

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15
Q

Drugs causing AGEP

A 
Tetracylines
Antifungals
Calcium channel blockers
Paracetamol 
Hydroxychloroquine
Carbamazepine
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16
Q

Treating AGEP

A

Antihistamine
Emoillents/ Soap Substitution
Topical Steroid

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17
Q

Drug hypersensitivity syndrome (DRESS)

A

Drug reaction with eosinophilia and systemic symptoms. Severe reaction 2-8 weeks following drug initiation

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18
Q

Presentation of DRESS

A

Widespread rash: Maculopapular, pustules, erythroderma

Multi-organ involvement: lymphadenopathy, hepatitis, pericarditis, interstitial nephritis, pneumonitis

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19
Q

Drugs causing DRESS

A

Antiepileptics
Sulphonamides
Allopurinol

20
Q

Diagnostic criteria for DRESS

A 
Hospitalisation
Suspected drug reaction 
Acute skin rash 
Fever >38C
Lymphadenopathy at 2 sites 
At least 1 other organ involved
Thrombocytopenia/ Eosinophilia
21
Q

Treatment of DRESS

A

Antihistamine
Emoillents
Topical Steroids

22
Q

Erythroderma

A

Inflammation of entire skin surface, pruritis, hair loss, hyperkeratosis palms, lymphadenopathy

23
Q

Complications of Erythroderma

A 
Secondary infection
Loss of thermoregulation
High cardiac output failure
Fluid and electrolyte imbalance
Hypoalbuminaemia
24
Q

Causes of erythroderma

A 
Drugs
Dermatitis: atopic eczema, contact dermatitis
Psoriasis
Immunobullous disorders
Pityriasis rubra pilaris (PRP)
Cutaneous T-Cell Lymphoma
Systemic Malignancy 
HIV
25
Q

Emoillents for Erythroderma

A

Hydromol ointment

Dermol 500 lotion

26
Q

Erythema Multiforme (EM)

A

Type 4 Hypersensitivity reaction, eruption of 3 zoned target lesions. Usually second to infection: HSV< viruses, vaccines

27
Q

Drugs causing Erythema Multiforme

A

Sulphonamides
Anticonvulsants
Allopurinol
Antibiotics

28
Q

Risk factors for Erythema Multiforme

A

Male, pregnancy, live vaccines, Slow acetylators, SLE, IBD, chemotherapy

29
Q

Features of Erythema Multiforme

A

Prodromal flu-like illness
Acral rash
May Koebnerise (formation of linear lesions)

30
Q

Investigations for Erythema Multiforme

A

Biopsy

FBC: leucocytosis, lymphocyted, eosinophilia, neutrophilalia, thrombocytopenia

31
Q

Treatment of Erythema Multiforme

A 
Withdrawal of cause
Antihistmaines 
Analgesia
Mouthwashes
Topical Steroids
Aciclovir for 6-12 months
32
Q

Erythema Multiforme Minor

A
  • Typical targets, oedematous plaques

- Acral distribution

33
Q

Erythema Multiforme Major

A
  • Typical targets, oedamtous plaques
  • Acral distribution
  • Mucous membrane involvement
  • <10 % of total body surface area (TBSA) epidermal detachment
34
Q

Steven Johnsosns and Toxic Epidermal Necrolysis

A
  • Widespread blisters
  • Erythematous or pruritic macules
  • Mucous membrane involvement
  • Epidermal detachment: <10% for SJS, >30% for TEN
35
Q

Signs of SJS and TEN

A

Erythroderma, facial oedema, skin pain, palpable purpura, skin necrosis, blisters, mucous membrane erosion, swelling of tongue

36
Q

Complications of SJS and TEN

A 
Lack of thermoregulation 
Hypotension 
Reduced consciousness
Oliguria
Labile glucose readings
Respiratory compromise
Ocular problems
Mucosal scarring
Oesophageal stricturing
Pain Arthralgia
37
Q

SCORTEN

A

Severity illness score for TEN. 1 point each:

  • Age>40
  • Malignancy
  • Tachycardia >120
  • Initial TBSA >10%
  • Urea >10
  • Glucose >14
  • Bicarbonate >20
38
Q

Treatment of SCORTEN

A

ICU if SCORTEN >3

39
Q

Urticaria (Hives)

A
  • Type 1 Hypersensitivity
  • Wheals: recurrent, transient oedematous lesions persisting <24 hours
  • Asymptomatic, pruritic, painful
40
Q

Angioedema

A
  • Oedema of dermis and subcatenous tissue

- Associated with urticaria (40%) or alone (10%)

41
Q

Causes of Urticaria and Angioedema

A

Drugs, foods, contact reaction (latex, hairdye), insect stings, infections, connective tissue disease, internal malignancy, C1 esterase inhibitor deficiency

42
Q

Management of Type 1 Hypersensitivity (if anaphylaxis)

A
  • 1:1000 Adrenaline IM (0.5ml)
  • Airway Management Oxygen
  • IV fluid challenge
  • IV antihistamine (10mg chlorphenamine)
  • Systemic steroid (200mg IV hydrocortisone)
43
Q

Management of Type 1 Hypersensitivity (without anaphylaxis)

A
  • Antihistamines
  • Systemic steroids
  • Anti-pruritic emollients
44
Q

Sedating Antihistaimes

A

Chlorphenamine 4mg QDS

Hydroxyzine 50mg OD

45
Q

Non-sedating Antihistamines

A

Cetirizine 10mg OB-BD

Fexofenadine 180mg OD-BD

46
Q

Systemic Steroid

A

Prednisolone 5mg/kg 5 days then stop

47
Q

Anti-pruritic emollients

A 
Balneum plus (Lauryl Macrogols)
Dermacool (menthol in aqueous)

SS: Dermatology (12 decks)

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