Dermatology - acute/emergency Flashcards by Hannah Falconer

What is erythroderma?

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

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What are some causes of erythroderma?

Psoriasis
Eczema
Drugs
Cutaneous lymphoma
Hereditary disorders
Unknown

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How would you manage someone with erythroderma?

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

1-2 weeks

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What is an example of a mild drug skin reaction?

Morbilliform exanthem (rash)

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What are examples of severe skin drug reactions?

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

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Which drugs are SJS/TEN secondary to commonly?

Antibiotics
Anticonvulsants - valproate
Allopurinol (gout)
NSAIDs

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How much body surface does the rash in SJS cover?

<10%

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What are the clinical features of SJS?

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

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What is Nikolsky’s sign?

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

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What is the mortality for SJS?

Up to 10%

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What is the mortality for TEN?

Up to 30%

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

SCORTEN

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What are the factors used when doing SCORTEN?

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

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What is points system for SCORTEN?

0-5

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

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

What is the management for SJS/TEN?

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

What is erythema multiforme?

Hypersensitivity reaction usually triggered by infection

What is the most common infection to cause erythema multiforme?

HSV

Then mycoplasma pneumonia

What does DRESS stand for?

Drug reaction with eosinophilia and systemic symptoms

What are the clinical signs for DRESS?

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

What happens in pemphigus?

Antibodies targeted at desmosomes

What happens in pemphigoid?

Antibodies targeted at desmo-epidermal junction

What are the features of pemphigus?

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

What are the features of pemphigoid?

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

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

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

What are the clinical features of eczema herpeticum?

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

What is the treatment for eczema herpeticum?

Aciclovir

What is eczema herpeticum caused by?

Herpes virus infection on a background of poorly controlled eczema

Who does staphylococcal scalded skins syndrome usually affect?

Children and immunocompromised adults

What are the clinical features of staphylococcal scalded skins syndrome?

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

What is urticaria?

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

What is the treatment for staphylococcal scalded skins syndrome?

IV antibiotics

What is angioedema?

Deeper swelling of skin or mucous membranes

What are the causes of acute urticaria?

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

What is the treatment for acute urticaria?

Oral antihistamine Short course oral steroid Avoid opiates and NSAIDs

What are the causes of chronic urticaria?

Autoimmune/idiopathic Physical Vasculitic Rarely Type I hypersensivity reaction

What is the treatment for chronic urticaria?

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