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Year 4 - Special Senses > Dermatology - Acute Dermatology > Flashcards

Dermatology - Acute Dermatology Flashcards

1
Q

What is urticaria?

A

Oedema of the dermis, raising the epidermis.

Secondary to increased permeability of capillaries, secondary to histamine release from mast cells.

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2
Q

What is angioedema?

A

Deeper swelling of the dermis and subcutnaeous tissue, often causing swelling of the tongue and lips.

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3
Q

What are the features of anaphylaxis?

A
  • bronchospasm
  • angioedema
  • hypotension
  • urticaria
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4
Q

Management of urticaria.

A

Antihistamines

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5
Q

Management of angioedema.

A

Corticosteroids

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6
Q

Management of anaphylaxis.

A

500mcg 1:1000 IM adrenaline (adults).

300mcg 1:1000 IM adrenaline (children).

150mcg 1:1000 IM adrenaline (infants).

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7
Q

Complications of

a) urticaria

b) angioedema

c) anaphylaxis

A

a) uncomplicated when alone

b) asphyxia, cardiac arrest and death

b) asphyxia, cardiac arrest and death

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8
Q

What is erythema nodosum?

A

Discrete tender nodules on the shins that indicate hypersensitivity.

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9
Q

Causes of erythema nodosum.

A
  • group A streptococcus
  • primary TB
  • pregnancy
  • malignancy
  • sarcoidosis
  • IBD
  • chlamydia
  • leprosy
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10
Q

What is erythema multiforme?

A

An acute self-limiting inflammatory condition, with herpes simplex virus being the main precipitating factor.

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11
Q

What is Stevens-Johnson syndrome?

A

A rare and unpredictable reaction to a medication, causing skin and mucosal loss.

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12
Q

What drug class is most commonly associated with Steven-Johnson syndrome?

A

Antibiotics

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13
Q

Features of Steven-Johnson syndrome.

A

Features usually begin within a week of starting abx:
- prodromal symptoms
- tender / painful rash
- mucosal involvement

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14
Q

Mucosal sites affected in Steven-Johnson syndrome.

A

At least 2 mucosal sites:
- eyes
- lips / mouth
- pharynx / oesophagus
- genital area
- trachea / bronchi
- GI tract (diarrhoea)

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15
Q

Complications of Steven-Johnson syndrome.

A
  • dehydration
  • infection
  • ARDS
  • GI ulceration / perforation
  • sepsis
  • DIC
  • VTE
  • toxic epidermal necrosis (TEN)
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16
Q

How is SJS diagnosed?

A
  • skin detachment <10% BSA
  • widespread erythematous / purpuric macules / atypical targets
17
Q

How is TEN diagnosed?

A
  • skin detachment >30% BSA
  • widespread purpuric macules / atypical targets
18
Q

How is mortality in SJS and TEN predicted?

A

SCORTEN - illness severity score.

+1 point for each criteria present at time of admission:

1) Age > 40 years
2) Presence of malignancy (cancer)
3) Heart rate > 120
4) Initial percentage of epidermal detachment > 10%
5) Serum urea level > 10 mmol/L
6) Serum glucose level > 14 mmol/L
7) Serum bicarbonate level < 20 mmol/L.

SCORTEN 0-1 > 3.2%
SCORTEN 2 > 12.1%
SCORTEN 3 > 35.3%
SCORTEN 4 > 58.3%
SCORTEN 5 or more > 90%

19
Q

Management of SJS / TEN.

A
  • stop causative drugs
  • hospital admission
  • fluidised air bed
  • sepsis 6
  • pain relief
20
Q

How long does the acute phase of SJS last?

A

10 days

21
Q

Long term consequences of SJS / TEN.

A
  • pigment change
  • skin scarring
  • loss of nails
  • scarred genitalia
  • blindness
  • lung disease (e.g. bronchiolitis, bronchiectasis, obstruction)
22
Q

What is erythroderma?

A

An exfoliative dermatitis involving at least 90% of the skin surface.

23
Q

Causes of erythroderma.

A
  • eczema
  • psoriasis
  • lymphoma
  • drugs
24
Q

Presentation of erythroderma.

A
  • inflammed, oedematous and scaly skin
  • lymphadenopathy
  • malaise
  • systemically unwell
25
Q

Treatment of erythroderma.

A
  • treat underlying cause
  • emollients and wet-wraps (skin hydration)
  • topical steroids
26
Q

Complications of erythroderma.

A
  • secondary infection
  • dehydration
  • electrolyte imbalance
  • hypothermia
  • high-output cardiac failure
  • capillary leak syndrome
27
Q

Prognosis of erythroderma.

A

Mortality ~30%

28
Q

What is eczema herpeticum?

A

A serious complication of atopic eczema, where co-infection with herpes simplex virus results in widespread eruption.

29
Q

Management of eczema herpeticum.

A
  • admission to hospital
  • antivirals (e.g. aciclovir)
  • antibiotics (ie. secondary bacterial infection)
30
Q

Complications of eczema herpeticum.

A
  • herpes hepatitis
  • encephalitis
  • DIC
  • death (rare)
31
Q

What is necrotising fasciitis?

A

A rapidly spreading infection of the deep fascia, with secondary tissue necrosis.

32
Q

Causes of necrotising fasciitis.

A
  • Group A haemolytic streptococcus
  • anaerobic / aerobic bacteria
33
Q

Presentation of necrotising fasciitis.

A
  • severe pain
  • erythematous, blistering necrotic skin
  • systemically unwell
  • surgical emphysema
34
Q

Management of necrotising fasciitis.

A

Urgent surgical referral for extensive surgical debridement.

IV antibiotics.

35
Q

Prognosis of necrotising fasciitis.

A

Mortality up to 76%

Year 4 - Special Senses (17 decks)

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