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Dermatology > Dermatology - acute/emergency > Flashcards

Dermatology - acute/emergency Flashcards

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Dermatology Board Prep flashcards
1
Q

What is erythroderma?

A

Any inflammatory skin disease affecting >90% of total skin surface

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2
Q

What are some causes of erythroderma?

A 
Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders
Unknown
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3
Q

How would you manage someone with erythroderma?

A 
ITU/burns unit
Remove any offending drugs
Careful fluid balance
Good nutrition
Temp regulation
Emollients - paraffin
Oral and eye care
Treat infection
Manage itch
Disease specific therapy/treat underlying cause
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4
Q

Usually, how long after starting a drug would a drug reaction occur?

A

1-2 weeks

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5
Q

What is an example of a mild drug skin reaction?

A

Morbilliform exanthem (rash)

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6
Q

What are examples of severe skin drug reactions?

A

Erythroderma
Stevens Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN)
DRESS

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7
Q

Which drugs are SJS/TEN secondary to commonly?

A

Antibiotics
Anticonvulsants - valproate
Allopurinol (gout)
NSAIDs

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8
Q

How much body surface does the rash in SJS cover?

A

<10%

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9
Q

What are the clinical features of SJS?

A

Fever, malaise, arthralgia
Rash - maculopapular, target lesions, blisters
Mouth ulceration, greyish white membrane, haemorrhagic crusting
Ulceration of other mucous membranes

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10
Q

What is Nikolsky’s sign?

A

Slight rubbing of the skin results in exfoliation of the outermost layer

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11
Q

What is the mortality for SJS?

A

Up to 10%

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12
Q

What is the mortality for TEN?

A

Up to 30%

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13
Q

What is the scoring system for prognosis for SJS/TEN?

A

SCORTEN

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14
Q

What are the factors used when doing SCORTEN?

A 
Age >40
Malignancy
Heart rate >120
Initial epidermal detachment >10%
Serum urea >10
Serum glucose >14
Serum bicarbonate <20
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15
Q

What is points system for SCORTEN?

A

0-5

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16
Q

What are the possible long term complications of SJS/TEN?

A 
Pigmentary skin changes
Scarring
Eye disease and blindness
Nail and hair loss
Joint contractures
17
Q

What is the management for SJS/TEN?

A 
Identify and stop culprit drug ASAP
Supportive therapy
?high dose steroids
?IV immunoglobulins
?anti-TNF therapy
?ciclosporin
18
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infection

19
Q

What is the most common infection to cause erythema multiforme?

A

HSV

Then mycoplasma pneumonia

20
Q

What does DRESS stand for?

A

Drug reaction with eosinophilia and systemic symptoms

21
Q

What are the clinical signs for DRESS?

A

Fever, widespread rash
Eosinophilia and deranged liver function
Lymphadenopathy
+/- other organ involvement

22
Q

What happens in pemphigus?

A

Antibodies targeted at desmosomes

23
Q

What happens in pemphigoid?

A

Antibodies targeted at desmo-epidermal junction

24
Q

What are the features of pemphigus?

A

Blisters very fragile and may not be seen intact, mucous membranes usually affected, patients usually unwell if extensive, uncommon, middle-aged patients

25
Q

What are the features of pemphigoid?

A

Blisters often intact and tense, patients usually well even if extensive, common, elderly patients

26
Q

What are the clinical features of erythrodermic psoriasis or pustular psoriasis?

A

Rapid development of generalised erythema +/- clusters of pustules (if pop, pus will be sterile, no signs of infection)
Fever, elevated WCC

27
Q

What are the clinical features of eczema herpeticum?

A

Fever and lethargy

Monomorphic blisters and ‘punched out’ erosions, generally painful, not itchy

28
Q

What is the treatment for eczema herpeticum?

A

Aciclovir

29
Q

What is eczema herpeticum caused by?

A

Herpes virus infection on a background of poorly controlled eczema

30
Q

Who does staphylococcal scalded skins syndrome usually affect?

A

Children and immunocompromised adults

31
Q

What are the clinical features of staphylococcal scalded skins syndrome?

A

Fever and irritability
Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation (skin peeling) follows

32
Q

What is urticaria?

A

Central swelling variable size, surrounded by erythema (dermal oedema)

33
Q

What is the treatment for staphylococcal scalded skins syndrome?

A

IV antibiotics

34
Q

What is angioedema?

A

Deeper swelling of skin or mucous membranes

35
Q

What are the causes of acute urticaria?

A

Idiopathic
Infection (usually viral)
Drugs (IgE mediated)
Food (IgE mediated)

36
Q

What is the treatment for acute urticaria?

A

Oral antihistamine
Short course oral steroid
Avoid opiates and NSAIDs

37
Q

What are the causes of chronic urticaria?

A

Autoimmune/idiopathic
Physical
Vasculitic
Rarely Type I hypersensivity reaction

38
Q

What is the treatment for chronic urticaria?

A

Oral antihistamines
Higher dose antihistamines
Second line agent e.g. anti-leukotriene
Immunomodulant e.g. omalizumab

Dermatology (9 decks)

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