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Clinical lectures: Yr2 > Dermatological emergency rashes > Flashcards

Dermatological emergency rashes Flashcards

1
Q

What is toxic shock syndrome (TSS)?

A

Infection caused by bacterial (S. aureus or strep A) toxins that can result in multiorgan failure

TSS is associated with Toxic Shock Syndrome Toxin-1 (TSST-1)

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2
Q

What percentage of TSS cases are associated with tampon use?

A

~50%

TSS is more common in menstruating women

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3
Q

List non-menstruation associated causes of TSS.

A
  • Post-cesarean delivery
  • Endometritis
  • Mastitis
  • Wound/skin injections
  • Burns
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4
Q

What is the characteristic rash associated with TSS?

A

Erythematous, macular, scaly ‘sun-burn’ rash that later presents with desquamation in large sheets

Mostly distributed on palms and soles but can be diffuse over the whole body

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5
Q

What are some associated signs of TSS?

A
  • Red mouth
  • ‘Strawberry’ tongue
  • Sclera
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6
Q

What are the potential complications of TSS?

A
  • Acute Respiratory Distress Syndrome (ARDS)
  • Hypotension
  • Septic shock
  • Acute kidney injury (AKI)
  • Shock liver
  • Altered mental state
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7
Q

What are the diagnostic criteria for TSS?

A

Diagnosed based on specific criteria for staph or strep TSS

These criteria help differentiate TSS from other conditions

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8
Q

What is the initial management for TSS?

A
  • IV fluids
  • Antibiotics
  • Possibly IV immunoglobulins

Urgent diagnosis and treatment are crucial

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9
Q

What supportive therapies may be needed in TSS management?

A
  • Ventilation for ARDS
  • Dialysis for renal injuries
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10
Q

What is an important step in the management of TSS related to the primary cause?

A

Removal of the primary cause

This may include infected tampons, surgical drainage of abscesses, or debridement of necrotizing fasciitis

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11
Q

What is Staphylococcal Scalded Skin Syndrome (SSSS)?

A

A blistering skin disorder characterized by the detachment of the epidermis, caused by Staphylococcal epidermolytic toxins A, B, D (ETA, ETB, ETD).

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12
Q

Who is most affected by SSSS?

A

Children under 5 years old and immunocompromised adults.

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13
Q

What is the typical presentation of SSSS?

A

Erythematous, tender rash that originates at the face, groin, axillae, then diffuses over the body but spares palms and soles.

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14
Q

What does the ‘scalded’ appearance in SSSS indicate?

A

Bullae and desquamation occur within 48 hours (positive Nikolsky’s sign).

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15
Q

What regions are usually affected in SSSS?

A

Only skin involvement that usually favors intertriginous regions, with no mucosal involvement.

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16
Q

What are common clinical features of SSSS?

A

Perioral and nasolabial crusting.

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17
Q

How is SSSS diagnosed?

A

Clinical diagnosis with bacterial swabs from possible sites of infection and purulent cultures from the patient.

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18
Q

What additional tests are done to exclude staph carriage?

A

Bacterial swabs from groin, axillae, and nostrils of family members.

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19
Q

What is done to exclude Toxic Epidermal Necrolysis (TEN)?

A

Skin snip sample (cutting of a piece of desquamated skin).

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20
Q

What is the first-line management for SSSS?

A

Flucloxacillin for 7-10 days.

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21
Q

What are the second-line options for managing SSSS?

A

Clarithromycin, azithromycin, or erythromycin for 7-10 days.

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22
Q

What is necrotising fasciitis?

A

A subset of aggressive bacterial SSTIs that cause necrosis of the muscle fascia and subcutaneous tissues.

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23
Q

How is necrotising fasciitis transmitted?

A

It is transmitted after skin trauma (e.g., bite, IV drug use, cut) or idiopathic causes.

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24
Q

What are some causative organisms of necrotising fasciitis?

A

Streptococcus pyogenes, Group B and C streptococci, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis.

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25
Q

What is the typical presentation of necrotising fasciitis?

A

Erythematous area that rapidly spreads, with severe pain upon palpation beyond the erythema.

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26
Q

What are some systemic symptoms of necrotising fasciitis?

A

Fever, toxicity, which can lead to organ failure, shock, and death.

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27
Q

What are the key findings upon examination of necrotising fasciitis?

A

Bullae formation, necrosis, gangrene, and wooden-hard induration of subcutaneous tissues.

28
Q

What is the investigation method for diagnosing necrotising fasciitis?

A

Excisional deep skin biopsy and culture for identifying the causative organisms.

29
Q

What is the management approach for necrotising fasciitis?

A

Must be treated as a medical emergency with surgical debridement of necrotic tissue and antibiotics.

30
Q

What antibiotics are commonly used for necrotising fasciitis?

A

Gentamicin and clindamycin.

31
Q

What is eczema herpeticum?

A

A contagious disseminated infection caused by HSV that presents in patients with atopic dermatitis.

32
Q

What is the presentation of eczema herpeticum?

A

Diffuse clusters of monomorphic (identical) vesiculopustular lesions that are umbilicated (new) or with crusting or punched-out erosions (old) in areas of pre-existing eczema.

33
Q

What complications can arise from eczema herpeticum?

A

Eye involvement can present as herpetic keratoconjunctivitis and can lead to secondary bacterial infection which causes impetigo or cellulitis.

34
Q

How is eczema herpeticum diagnosed?

A

Clinical diagnosis, viral culture, and Tzanck smear showing characteristic multinucleated syncytial giant cells and acantholytic cells.

35
Q

What is a reliable lab test for identifying vesiculobullous skin lesions?

A

Tzanck smear is a reliable lab test to identify multiple types of vesiculobullous skin lesions.

36
Q

What is the management for eczema herpeticum?

A

Urgently treated with antivirals, oral or topical antibiotics for secondary infection, and ophthalmology referral.

37
Q

What is generalized pustular psoriasis?

A

A life-threatening form of psoriasis.

38
Q

What is the presentation of generalized pustular psoriasis?

A

Widespread sheets of sterile pustules on erythematous skin, associated with pyrexia and haemodynamic instability.

39
Q

What are the complications of generalized pustular psoriasis?

A

Complications include secondary bacterial infection, electrolyte disturbance, renal and liver impairment.

40
Q

What is DRESS?

A

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction to a drug.

41
Q

What drugs are most commonly associated with DRESS?

A

Most associated drugs include anticonvulsants (e.g., carbamazepine, phenobarbital), antiretrovirals (e.g., nevirapine), sulfonamide antibiotics, and allopurinol.

42
Q

What is the initial presentation of DRESS?

A

Initially presents with facial and neck edema, usually followed by widespread lymphadenopathy.

43
Q

What type of rash is associated with DRESS?

A

Widespread, maculopapular drug eruption with red papules, targetoid lesions, vesicles, and pustules, favoring the face, upper trunk, and extremities.

44
Q

What can the rash in DRESS progress to?

A

The rash can progress to erythroderma.

45
Q

How is DRESS diagnosed?

A

DRESS is diagnosed clinically.

46
Q

What investigations are done for DRESS?

A

FBC, vital observations to check for fever, CRP, ESR, and a viral swab to rule out viral infection.

47
Q

What is the management for DRESS?

A

Immediately withdraw all suspected offending drugs; should resolve within 2-6 weeks.

48
Q

What is the first-line treatment for DRESS?

A

First-line treatment includes emollients and topical corticosteroids (e.g., prednisolone).

49
Q

What is the second-line treatment for DRESS?

A

Second-line treatment includes systemic corticosteroids or IV methylprednisolone.

50
Q

What is the third-line treatment for DRESS?

A

Third-line treatment includes immunosuppressants (e.g., ciclosporin, MMF, rituximab).

51
Q

What is erythroderma?

A

Erythroderma is widespread and intense inflammatory reddening of the skin with associated severe itching and pain affecting >90% of the skin surface.

52
Q

What is the initial presentation of erythroderma?

A

Initially presents as a maculopapular eruption that progresses to widespread erythema.

53
Q

What are the symptoms associated with erythroderma?

A

Skin is tender and pruritic, leading to scaling and lichenification.

54
Q

How is erythroderma diagnosed?

A

Erythroderma is diagnosed clinically.

55
Q

What is the management for erythroderma?

A

Management includes emollients and mild-moderate topical steroids.

56
Q

When should systemic steroids be used in erythroderma?

A

Systemic steroids should be used if the condition is severe.

57
Q

What supportive care is needed for erythroderma?

A

IV fluids for dehydration and nutritional support, along with monitoring vital observations.

58
Q

What are Stevens-Johnson syndrome (SJS), SUS/TEN overlap, and Toxic Epidermal Necrolysis (TEN)?

A

Febrile mucocutaneous drug reactions on the same spectrum.

59
Q

What is the epidemiology of SJS and TEN?

A

Mostly associated with use of NSAIDs, anticonvulsants, sulfonamides.

SJS is more common in children and young adults, while TEN is more common in middle-aged and old adults.

60
Q

What are the stages of presentation for SJS and TEN?

A
  1. Prodromal stage: fever, malaise, upper respiratory symptoms. 2. Cutaneous stage: Erythematous macules coalesce into large patches, then become bullae.
61
Q

What happens to bullae in the cutaneous stage?

A

Bullae burst easily and cause skin desquamation, leaving painful erosions that resemble hot-water burn and are necrotic.

62
Q

What are typical oral and ocular involvements in SJS and TEN?

A

Oral involvement: Upper and lower lips swollen and bright red with erosions and hemorrhagic crusting. Ocular involvement: Bilateral conjunctival injections.

63
Q

What is the classification of SJS and TEN based on skin peeling?

A

SJS: Skin peeling on below 10% body surface area. SJS/TEN overlap: Skin peeling on 10-30% body surface area. TEN: Skin peeling on over 30% body surface area.

64
Q

How is SJS and TEN diagnosed?

A

Clinical diagnosis.

Kawasaki disease doesn’t cause necrosis of mucosal surfaces or severe blistering, erosion, crusting.

65
Q

What is the management for SJS and TEN?

A

Immediate withdrawal of offending drug and supportive care. Treat like severe burns.

66
Q

What are some specific management strategies for SJS and TEN?

A

Don’t manipulate intact or detached areas, keep detached areas covered with dressing until wound is closed. Frequent swabs from potentially infected areas, blood and urine cultures to monitor infection.

67
Q

When should referral occur in the management of SJS and TEN?

A

Referral depending on organ involvement.

Clinical lectures: Yr2 (52 decks)

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