Dermatological Emergencies Flashcards
Conditions in Dermatological Emergencies
Eczema herpeticum Drug Eruptions Erythroderma Erythem Multiforme Urticaria & angioedema
Eczema Herpeticum
Serious complication of Eczema caused by Herpes Simplex Virus
Presentation of Eczema Herpeticum
Extensive blisters, fever and malaise
Treating Eczema Herpeticum
IV Aciclovir and antibiotics
Complications of Eczema Herpeticum
Hepatitis
Encephalitis
Disseminated intravascular coagulation
Presentation of Drug eruptions
Facial involvement, widespread erythema, skin pain, blistering, purpura, necrosis, fever, lymphadenothpathy, arthralgia, shock
Type 1 Anaphylactic drug reactions
Anaphylaxis, urticaria, angioedema
Type 2 Cytotoxic drug reactions
Pemphigoid, Pemphigus, Thrombocytopenia
Type 3 Immune Complex Mediated drug reaction
Serum sickness, vasculitis
Type 4 Cell-mediated drug reaction
Contact allergy, DRESS, Morbilliform rash, TEN
Morbilliform
rash that looks like measles, 5-10 day onset, fever, malaise, maculopapula, symmetrical, can progress to erythroderma
Drugs causing Morbilliform
Penicillin Erthromycin Carbamazepine Allopurinol NSAIDs Phenytoin
Treating Morbilliform
Antihistamine
Emoillents/ Soap Substitution
Topical Steroid
Acute Generalised Exanthematous Pustulosis (AGEP)
Skin reaction with rapid onset, starting in face and flexures, fever, malaise, neutrophil leucocytosis
Drugs causing AGEP
Tetracylines Antifungals Calcium channel blockers Paracetamol Hydroxychloroquine Carbamazepine
Treating AGEP
Antihistamine
Emoillents/ Soap Substitution
Topical Steroid
Drug hypersensitivity syndrome (DRESS)
Drug reaction with eosinophilia and systemic symptoms. Severe reaction 2-8 weeks following drug initiation
Presentation of DRESS
Widespread rash: Maculopapular, pustules, erythroderma
Multi-organ involvement: lymphadenopathy, hepatitis, pericarditis, interstitial nephritis, pneumonitis
Drugs causing DRESS
Antiepileptics
Sulphonamides
Allopurinol
Diagnostic criteria for DRESS
Hospitalisation Suspected drug reaction Acute skin rash Fever >38C Lymphadenopathy at 2 sites At least 1 other organ involved Thrombocytopenia/ Eosinophilia
Treatment of DRESS
Antihistamine
Emoillents
Topical Steroids
Erythroderma
Inflammation of entire skin surface, pruritis, hair loss, hyperkeratosis palms, lymphadenopathy
Complications of Erythroderma
Secondary infection Loss of thermoregulation High cardiac output failure Fluid and electrolyte imbalance Hypoalbuminaemia
Causes of erythroderma
Drugs Dermatitis: atopic eczema, contact dermatitis Psoriasis Immunobullous disorders Pityriasis rubra pilaris (PRP) Cutaneous T-Cell Lymphoma Systemic Malignancy HIV
Emoillents for Erythroderma
Hydromol ointment
Dermol 500 lotion
Erythema Multiforme (EM)
Type 4 Hypersensitivity reaction, eruption of 3 zoned target lesions. Usually second to infection: HSV< viruses, vaccines
Drugs causing Erythema Multiforme
Sulphonamides
Anticonvulsants
Allopurinol
Antibiotics
Risk factors for Erythema Multiforme
Male, pregnancy, live vaccines, Slow acetylators, SLE, IBD, chemotherapy
Features of Erythema Multiforme
Prodromal flu-like illness
Acral rash
May Koebnerise (formation of linear lesions)
Investigations for Erythema Multiforme
Biopsy
FBC: leucocytosis, lymphocyted, eosinophilia, neutrophilalia, thrombocytopenia
Treatment of Erythema Multiforme
Withdrawal of cause Antihistmaines Analgesia Mouthwashes Topical Steroids Aciclovir for 6-12 months
Erythema Multiforme Minor
- Typical targets, oedematous plaques
- Acral distribution
Erythema Multiforme Major
- Typical targets, oedamtous plaques
- Acral distribution
- Mucous membrane involvement
- <10 % of total body surface area (TBSA) epidermal detachment
Steven Johnsosns and Toxic Epidermal Necrolysis
- Widespread blisters
- Erythematous or pruritic macules
- Mucous membrane involvement
- Epidermal detachment: <10% for SJS, >30% for TEN
Signs of SJS and TEN
Erythroderma, facial oedema, skin pain, palpable purpura, skin necrosis, blisters, mucous membrane erosion, swelling of tongue
Complications of SJS and TEN
Lack of thermoregulation Hypotension Reduced consciousness Oliguria Labile glucose readings Respiratory compromise Ocular problems Mucosal scarring Oesophageal stricturing Pain Arthralgia
SCORTEN
Severity illness score for TEN. 1 point each:
- Age>40
- Malignancy
- Tachycardia >120
- Initial TBSA >10%
- Urea >10
- Glucose >14
- Bicarbonate >20
Treatment of SCORTEN
ICU if SCORTEN >3
Urticaria (Hives)
- Type 1 Hypersensitivity
- Wheals: recurrent, transient oedematous lesions persisting <24 hours
- Asymptomatic, pruritic, painful
Angioedema
- Oedema of dermis and subcatenous tissue
- Associated with urticaria (40%) or alone (10%)
Causes of Urticaria and Angioedema
Drugs, foods, contact reaction (latex, hairdye), insect stings, infections, connective tissue disease, internal malignancy, C1 esterase inhibitor deficiency
Management of Type 1 Hypersensitivity (if anaphylaxis)
- 1:1000 Adrenaline IM (0.5ml)
- Airway Management Oxygen
- IV fluid challenge
- IV antihistamine (10mg chlorphenamine)
- Systemic steroid (200mg IV hydrocortisone)
Management of Type 1 Hypersensitivity (without anaphylaxis)
- Antihistamines
- Systemic steroids
- Anti-pruritic emollients
Sedating Antihistaimes
Chlorphenamine 4mg QDS
Hydroxyzine 50mg OD
Non-sedating Antihistamines
Cetirizine 10mg OB-BD
Fexofenadine 180mg OD-BD
Systemic Steroid
Prednisolone 5mg/kg 5 days then stop
Anti-pruritic emollients
Balneum plus (Lauryl Macrogols) Dermacool (menthol in aqueous)
