Dermatology - emergencies

Question 1

What are the main dermatological emergencies?

Answer 1

Erythroderma from any cause
Severe adverse drug reaction
Infection-related issues

Question 2

What is erythroderma?

Answer 2

Intense reddening of the skin, often followed by massive exfoliation (exfoliation dermatitis)

Question 3

Causes of erythroderma

Answer 3

• Infection
  
  • Drug reaction
  • Psoriasis
  • Less common
    ○ HIV
    ○ Paraneoplastic syndrome
    ○ Other

Question 4

Complications of erythroderma

Answer 4

• Temperature irregulation
  
  • Fluid and electrolyte disturbances
  • Infection risk
  • Haemodynamic instability
  • Death

Question 5

Treatment for erythroderma

Answer 5

Emollients, corticosteroids, wet wraps

Treat underlying cause

Question 6

What are the severe dermatological drug reactions?

Answer 6

• TEN
  
  • Steven-Johnson syndrome
  • Red man syndrome (idiopathic erythroderma)
  • DRESS
  • AGEP

Question 7

What does DRESS stand for? (derm)

Answer 7

• drug reaction with eosinophilia and systemic symptoms

Question 8

Which two dermatological drug reactions are throught to be the same process but on different ends of the spectrum?

Answer 8

TEN and SJS

Question 9

What doe TEN stand for (derm condition)

Answer 9

Toxic epidermal necrolysis

Question 10

Which condition is more serious, TEN or SJS?

Answer 10

TEN

Question 11

Clinical features of Steven Johnson’s syndrome?

Answer 11

○ a targetoid atypical rash (<10% of body surface area)
○ Eye and genital ulcerations possible and are serious issues
○ Haemorrhagic stomatitis

Question 12

Management of SJS?

Answer 12

Stop drug

Question 13

What is the pathology of TEN?

Answer 13

Widespread keratinocyte necrosis provoked by cell mediated cytotoxic reaction

Question 14

What causes TEN?

Answer 14

Over 220 drugs implicated

Common ones: Sulfonamids, anticonvulsants, NSAIDs, Dapsone, allopurinol, other antibiotics

vaccines (MMR)

Polio

Question 15

Extra-cutaenous manifestations of TEN?

Answer 15

○ Fever
○ Purulent conjunctivitis
○Mucositis (GI, resp, genitals)

Question 16

Prognostic indicators for TEN/ SJS

Answer 16

SCORETEN score

Thrombocytopaenia/ neutropania

delayed admission, treatment with corticosteroids

Question 17

Complications of TEN/ SJS?

Answer 17

○ Sepsis
	○ Multiorgan failure (>30%)
	○ Metabolic abnormalities
	○ Pulmonary isses (>15%) - E.g. embolus
	○ GI haemorrhage

Question 18

What is the management for toxic epidermal necrolysis?

Answer 18

• Withdraw the drug
  
  • Admit to burns unit - supportive measures
    ○ Fluids and electrolytes
    ○ thermoregulation
    ○ Monitor for complications - infections
  • No steroids!
  • IVIG or plasmapharesis (controversial)

Question 19

What is the rash like in DRESS syndrome?

Answer 19

non specific

Question 20

What are the systemic symptoms in DRESS syndrome?

Answer 20

Fever, hepatitis, lympadenopathy pneumonitis, nephritis

Question 21

What is the management of DRESS syndrome?

Answer 21

withdraw the drug

may need systemic prednisolone

Question 22

What does AGEP stand for? (derm condition)

Answer 22

acute generalised exanthematous pustulosis

Question 23

Which medications does AGEP tend to occur in?

Answer 23

Antibiotics in particular

Question 24

Clinical picture in AGEP?

Answer 24

24-48h after the medication
pustules everywhere
can be febrile, unwell
usually resolves with desquamation once drug ceased

Question 25

What are the two main dermatological emergencies are related to infection?

Answer 25

Scalded skin syndrome

Toxic shock syndrome

Question 26

What bacteria cause scalded skin syndrome and toxic shock syndrome

Answer 26

SSS - staph aureus

TSS - staph aureus or strep pyogenes