Dermatology Flashcards
SCORETEN Toxic Epidermal Necrolysis Score
- Age > 40yrs
- Presence of cancer or Haematological malignancy
- HR > 120
- Epidermal skin detachment > 10% TBSA Day 1
- Urea > 10mmol/l
- Glucose > 14mmol.l
- Bicarb < 20mmol/l
Mortality
0-1 = 3.2%
2 = 12%
3 = 35%
4 = 58%
5 or more 90%
Nikolsky +ve Disease
- SJS/TENS
- SSSS
- Pemphigus vulgaris
- Bullous pemphigoid
- ?? Erythroderma
Derm nomenclature
Macule = flat lesion
Papule = < 5mm Raised lesion
Petechia = <2mm
Purpura = 3-10mm
Ecchymosis = >1cm
Vesicle = <5mm fluid filled
Bulla = >5mm fluid filled
Pustule = yellow/white fluid in vesicle/bulla
Plaque = raised distinct edge > 1cm
TENS vs AGEP vs
Rash differentiation
Pemphigus vs Pemphigoid
Erythroderma
Causes
Eczema (40%)
Psoriasis
Drugs
Lymphoma (Sezary syndrome)
Idiopathic
Complications
* High output cardiac failure
* Dehydrations secondary to transepidermal water loss
* Hypoalbuminaemia
* Electrolyte imbalance
* Hypothermia/temperature dysregulation
* Thrombophlebitis/DVT
* Infection - skin and pneumonia = major cause of death
Mx
Admit for supportive treatment -derm +/- ICU
* Avoid hypothermia
* IV fluid replacement to resus and maintenance
* Maintina UO
* Elelctrolyte replacement
* DVT prophylaxis
* Skin specific
* Emollients
* Wet wraps 3 x daily
* Topical steroid
* Parafin -> wet bandage -> dry bandage
* Antibiotics if infection
* ADT
Erythema Multiforme
Males
Younger age
Major and minor
Causes
90 % Infection - HSV, VZV, Mycoplasma, CMV, Adenovirus, HIV, Vaccines
10% Drugs - Penicillins, Sulphonamides, NSAIDS, AEDs. allopurinol
Immunisations
Malignancy - Leukaemia, lymphoma
DDx
Urticaria, viral exanthem, hypersensitivity reaction, cutaneous drug eruptions, Stevens-Johnson syndrome, toxic epidermal necrolysis, and vasculitis
SJS/ TENS
Petechiae vs purpura
Vesicles vs Bullae
Eczema
Pruritis
Ix Pruritis
Send blood for the following:
* FBE for eosinophilia
* Fe studies for deficiency
* Glucose level to screen for diabetes
* EUC to exclude renal failure
* LFTs to exclude hepatic impairment with
jaundice, including primary biliary cirrhosis
* serum protein electrophoresis to look for
a monoclonal gammopathy, particularly in
patients over 70 years
* thyroid stimulating hormone to exclude
hypothyroidism or hyperthyroidism
* coeliac serology, such as I Immunoglobulin
A (gA) tissue transglutaminase antibodies.
Take skin scrapes from any suspicious areas
for fungal culture and microscopy.
In suspected scabies, send material to look for scabies mites,
eggs or faeces on microscopy.
Pyoderma gangrenosum
It may begin as a discrete painful haemorrhagic pustule or grouped lesions that rapidly ulcerate, usually on the lower leg, causing larger lesions with neutrophilic inflammation with abscesses and necrosis
DDx - cutaneous vasculitis
No vasculitis on biopsy
Assoc w/ IBD, RA, blood dyscrasias, Behçet syndrome and malignancy, such as myeloma and leukaemia
Scabies
Common parasitic infection - itch
Epi
Elderly esp NH
Returned travellers
Presentation
Eczematous and/or urticarial
No pre-existing history of eczema.
Finger web spaces, flexures, wrists and the
instep of the feet, for scabies burrows, and the
penis and scrotum for scabetic nodules
Crusted ‘Norwegian’ scabies is predisposed to
by glucocorticoid therapy, organ transplant and
HIV infection and in the elderly.
Treatment
Application of 5% permethrin cream from neck down for 42 hours, and repeated in 1 week, is first-line therapy.
Oral ivermectin (200 mcg/kg) PO stat and repeated
in 1 week should be considered as second-line
therapy or in severe cases
