Dermatology emergencies Flashcards
Acute urticaria clinical features
Pale, pink raised skin
Pruritic
Acute urticaria mx
Non-sedating antihistamines (eg. cetirizine) are first line
- continue these for up to 6 weeks following an episode of acute urticaria
Sedating antihistamine (eg. chlorphenamine) may be considered for night-time use for troublesome sleep symptoms
Prednisolone - severe or resistant episodes
Uncomplicated drug reactions
Drug induced exanthem (morbilliform drug eruption)
Fixed drug eruption
Type 1 hypersensitivity reactions
Lichenoid drug eruptions
Phototoxic reactions
Severe cutaneous adverse reactions (SCAR)
DRESS
AGEP
SJS-TENS
DRESS
Drug reaction with eosinophilia and systemic symptoms (also known as drug induced hypersensitivity syndrome)
Presents with a morbilliform rash, with systemic symptoms eg. fever, potential multi-organ dysfunctionn, haematological abnormalities, neurological, endocrine or GI manifestations and raised eosinophils
Facial oedema is characteristic
Mx - stop offending agent, supportive treatment due to risk of dehydration, oral prednisolone, IVIG/plasma exchange if life threatening
AGEP
Acute generalised exanthematous pustulosis
Onset is sudden, within 24 hours of drug being commenced → patient febrile with an eruption of sterile pustules
Patient is unwell & rash is itchy & painful
Mx - stop offending agent, use of topical/systemic steroids with best supportive care
SJS-TENS
Steven Johnsons Syndrome and Toxic Epidermal Necrolysis are blistering, desquamating delayed T-cell reactions to drugs, with mucous membrane involvement
Takes many weeks for the reaction to develop after initial drug exposure
SJS = < 10% epidermal detachment, 10-30% = SJS-TENS overlap, > 30% = TENS
Typically carbamazepine, phenytoin & abacavir
SJS-TENS clinical features
Prodrome - viral symptoms
Followed by erythroderma, atypical target lesions & flaccid blisters
Multi-organ dysfunction & death can occur
Nikolsky’s sign is positive
SJS-TENS mx
Offending drug should be stopped
Nursing in a high acuity setting with burns centre management → use of special dressings & paying close attention to fluid loss and infection risk is necessary
Analgesia, support with hydration & nutrition, close monitoring
Ophthalmology input may be required due to eye involvement
Prognosis - SCORTEN & ABCD-10 criteria
Eczema herpeticum
Potentially serious widespread HSV infection, with typically affects people with atopic dermatitis or eczema
Eczema herpeticum clinical features
Appear 5-12 days after contact with an infected individual
Areas of rapidly worsening, painful eczema
Vesicular rash
Punched-out erosions
Possible fever, lethargy, lymphadenopathy or distress
Rarely → can spread to the eye (herpes keratitis) → ophthalmological referral
Eczema herpeticum ix
Viral infection can be confirmed by viral swabs → PCR, viral culture, direct fluorescent antibody stain
Herpetic keratitis → staining with fluorescein - stained dendritic ulcer is diagnostic
Eczema herpeticum mx
Prompt treatment with antiviral meds - oral aciclovir 5 times daily for 10-14 days (if vomiting → IV)
Ocular involvement:
- ganciclovir ointment five times daily for 7-10 days
- corneal transplant may be indicated where vision significantly affected by scarring
Eczema herpeticum complications
Secondary infection
Scarring
Herpetic keratitis
Organ failure & dissemination
Necrotising fasciitis
Life-threatening rapidly-progressing infection that spreads along the fascial planes & subcutaneous tissue
Surgical emergency
Fournier’s gangrene = specifically a necrotising infection of the perineum
