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Dermatology > Dermatology Emergencies- Belazarian > Flashcards

Dermatology Emergencies- Belazarian Flashcards

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1
Q

Describe DRESS and the common drugs associated with this syndrome.

A

Drug Rash, Eosinophilia, and Systemic Symptoms

  • Potentially fatal hypersensitivity to a med
  • Caused by alteration in drug metabolism- possibly due to HHV6.

Anticonvulsant Drugs:

  • Phenytoin
  • Carbamazepine
  • Phenobarbital
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2
Q

Describe the Clinical Picture of DRESS

A
  • Onset 4-6 weeks after starting drug
  • Fever initially
  • EDEMA of the face (hallmark)
  • Eosinophilia
  • Liver
  • Joints
  • Any major organ system
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3
Q

Describe the treatment of DRESS

A
  • Discontinue Offending drug
  • Corticosteroids

Note: Death usually due to fulminant hepatitis.

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4
Q

Describe Erythema Multiforme

A
  • AKA Erythema Multiform Minor
  • Self Limited and Recurrent (1-4 week Episodes)
  • Young adults
  • Targetoid Lesions (3 zones, Can be a bulla)
  • Acral

Note: This is part of the Continuum

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5
Q

Describe the etiology of Erythema Multiform

A
  1. Herpes Simplex (1-3 weeks before)
    - may or may not be clinically evident
  2. Mycoplasma
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6
Q

Describe the treatment of Erythema Multiforme

A

Prevention of Herpes Outbreak

  • Sunscreen
  • Antivirals (Acyclovir, Valacyclovir)
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7
Q

Describe Steven Johnson Syndrome

A
  • AKA Erythema Multiform major
  • < 10% of total BSA involved
  • 2 or more mucous membranes involved
  • Atypical targets (not 3 zones)
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8
Q

Describe the Clinical Features of Steven Johnson Syndrome

A

GFR PPD

  • Gritty eyes
  • Fever/ Flu-like prodrome
  • Red Tender skin –> Sloughing
  • Photosensitivity
  • Painful urination and bowel movements
  • Difficulty swallowing or eating
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9
Q

Describe Toxic Epidermal Necrolysis

A
  • > 30% of total BSA involved

- Target lesions are not common.

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10
Q

Describe the Clinical features of Toxic Epidermal Necrolysis

A

GFR PPD BNS

Gritty Eyes
Fever / Flu prodrome
Red tender skin
Photophobia
Painful urination/ bowel movements
Difficulty swallowing/ eating

Blisters*
Nikolsky Sign*
Skin Sloughing*

Histo: Epidermal Necrosis

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11
Q

List the causes of SJS and TEN

A
  • Trimethroprim-Sulfamethoxazole
  • Antibiotics
  • Anticonvulsants
  • Allopurinol
  • NSAIDS
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12
Q

Discuss the management of SJS and TEN

A
  • Withdraw offending drug
  • Burn Unit
  • Fluids/electrolytes
  • Temperature

-IV Steroids and/or Immunoglobulins (Controversial)

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13
Q

What is the mortality rate for SJS and TEN

A
  • 5%

- 30%

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14
Q

Describe Exfoliative Erythroderma

A
  • Many Etiologies
  • Redness and Scaling over >90% of the body
  • Older patients
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15
Q

Describe the clinical features of Exfoliative Erythroderma

A
  • Pruritis and Fatigue
  • Redness and scaling
  • Dermatopathic lymphadenopathy
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16
Q

Describe some of the associated etiologies of Exfoliative Erythroderma

A

AC IPAD

Atopic Dermatitis
Cutaneous T cell Lymphompa (mycosis fungoides)
Idiopathic
Psoriasis 
Allergic Contact Dermatitis
Drug Reaction
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17
Q

Name the emergency sequelae of Exfoliative Erythroderma

A

HD PIC

  • Heat fluid loss through skin –> Temperature instability
  • Dehydration
  • Protein loss
  • Infections
  • Congestive Heart failure (High output)
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18
Q

Describe the management of Exfoliative Erythroderma

A
  • Stop the offending drug
  • Treat underlying skin condition
  • Supportive Therapy: Temp, Fluids, hemodynamics
  • Topical Steroids
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19
Q

What is the mortality range for Exfoliative Erythroderma?-

A
  • 4.6 to 64%

- Relapse is common

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20
Q

Name the causative agent for Meningococcemia and describe the common setting that outbreaks are observed

A
  • Neisseria Meningitides
  • Schools
  • Military Barracks

Note: Transmission is through inhalation of aerosol droplets.

  • Nasopharyngeal infection
  • Hematogenous dissemination
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21
Q

Describe the pathophysiology of meningococcemia

A

Polysaccharide capsule important for virulence and serotyping

  • Damage to endothelium and release of LPS
  • Results in release of TNFa, IL-1, IL-6, and INFgamma

These Cytokines cause:

  • Hypotension
  • DIC
  • Multi-organ failure
  • Increased Vascular Permeability
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22
Q

Describe the risk factors for development of meningococemia

A
  • Young age
  • Asplenia
  • Immunoglobulin deficiency
  • Late complement deficiency (C5-C9)
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23
Q

Describe the clinical features of Meningococemia

A
  • Petechiae
  • Angular or Stellate lesions (with GUNMETAL grey center)
  • Pupura Fulminans
  • Fever Chills and Hypotension
  • Meningeal signs (80% develop meningitis)
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24
Q

Describe the Diagnosis and Treatment of Meningococcemia

A

Dx:

  • CSF and Blood Culture
  • Gram stain of Pustules show Gm-negative Diplococci

Rx:

  • Ceftriaxone
  • Ampicillin
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25
Q
  1. What is the causative agent for Rocky Mountain Spotted Fever
  2. What is the tick species that serves as the vector?
  3. What state is it common?
A
  • Rickettsia Rickettsii
  • Dermacentor tick
  • Common in North Carolina
  • Rarely in the Rocky Mountain states
26
Q

Describe the Pathogenesis of Rickettsia Rickettsi

A
  • Replicates in endothelium of Dermis
  • Spreads hematogenously and attaches to endothelial cell
  • Results in Vascular/ tissue injury
27
Q

Describe some of the systemic sequelae of Rocky Mountain Spotted fever

A

Multi-organ failure due to:

Vasculitis in:

  • Brain
  • Heart
  • Lungs
  • GI
  • Kidneys
  • Liver

Also promotes Coagulation cascade, resulting in:

  • Hypercoagulability
  • Thrombocytopenia
28
Q

Describe the Clinical Features of Rocky Mountain Spotted Fever

A
  • Fever
  • Headache
  • Photophobia
  • Hypotension
  • Blanchable macules –> Non-blanchable Papules (Hemorrhagic)
  • Starts on Wrists / Ankles –> Palms/ Soles –> Trunk / Face
29
Q

What is the Classic Rocky Mountain Spotted Fever Triad?

A
  • Fever
  • Rash
  • Headache
30
Q

What is the Gold Standard Rx for Rocky Mountain Spotted Fever?

A

Doxycycline

Note: We use the Dox to kill Dermacentor

31
Q

What is the pathogen implicated in Toxic Shock Syndrome?

What is the alternate (and more common) pathogen implicated in another variation of this syndrome?

A
  1. Staph Aureus
  2. Strep Pyogenes causes Streptococcal Toxic Shock Syndrome
    - More common!
32
Q

Describe the pathogenesis of s. aureus in TSS

A

There is a massive release of cytokines due to bacterial toxins acting as Superantigens.

33
Q

Describe the clinical picture of TSS

A
  • Generalized macular erythema (especially at the flexures)
  • Mucus membranes can be involved- strawberry tongue

-Follwed by 1-2 weeks of desquamation especially at palms and soles of feet.

34
Q

Describe the treatment for TSS

A
  • IV fluids and vasopressors

- Penicillinase resistant antibiotics

35
Q

Describe the mortality rates for the toxic shock syndrome caused by s. aureus and s. pyogenes, respectively.

A

Staph TSS mortality rate > 5%

Strep TSS mortality rate 30-70%

36
Q

What predisposes young girls to Staph aureus TSS?

A

Tampon Use

37
Q

In what population subtypes do we see disseminated HSV

A
  • Immunocompromised (HIV)
  • Newborns
  • Pregnant
  • Malignancies
38
Q

Patients with what skin condition are at risk for developing a viral associated condition?

A

Patients with ECZEMA are at risk for developing:

ECZEMA HERPETICUM

39
Q

What is the clinical appearance of disseminated HSV?

A

Clustered Erosions

40
Q

What do we use to diagnose Disseminated HSV?

A

To detect HSV, we use TDV

  • Tzanck smear
  • Direct Fluorescent antibody (DFA)
  • Viral Culture
41
Q

What is the Rx for Disseminated HSV?

A

IV Acyclovir

42
Q

Describe the Artheroembolic disease in its entirety

A
  • Small deposits of fibrin and cholesterol debris embolize from location and into smaller vessels in skin.
  • Spontaneous onset after intra-vascular procedure
  • Violaceous vascular pattern or blue toe; signs of necrosis
  • Can affect many organs
  • Dx: Biopsy
  • Rx: Anticoags.
43
Q

What is Calciphylaxis and what patients are at high risk for this?

A
  • Rare and serious condition in which there is calcification of the cutaneous arteries leading to tissue necrosis.
  • Patients with ESRD on dialysis are at increased risk for this.
44
Q

Describe the clinical picture for Calciphylaxis

A

Sudden onset of intense PAIN from necrotic/ indurated lesions.

Common locations:
Thighs
Butt
Lower abdomen

45
Q

Describe the Diagnosis, Management, and Mortality of Calciphylaxis.

A

Dx:

  • Deep biopsy showing Calcification of subcutaneous fat
  • Calcification of Medial layer of arterioles

Rx:

  • Control Calcium and Phosphorus levels
  • Parathyroidectomy (controversial)

Mortality:
-80%

46
Q

What is Porphyria Cutanea Tarda (PCT)?

A
  • Most common type of Porphyria
  • Fragile skin- bullae and vesicles on the hands after minor trauma.
  • Sporadic and acquired- d/t deficient enzyme in the Heme pathway
  • Alcohol exacerbates
47
Q

Describe Pyoderma Gangrenosum

A
  • Characterized by neutrophilic infiltration of the dermis and destruction of tissue
  • Rapidly progressive
  • Pustule –> Painful Ulcer with bluish edge
  • Can be as deep as the bone!

-Associated with IBDs and RA

48
Q

What is Erythema Nodosum?

A

A delayed type hypersensitivity response to a variety of different antigenic stimuli

49
Q

Where in the body are we likely to see the clinical manifestations of Erythema Nodosum?

A
  • Lower Legs, bilaterally.

- Anterior is common

50
Q

What are some of the common trigger of Erythema Nodosum?

A 
Sarcoidosis
TB
UC
Crohn's
Kontraceptive Oral pills
51
Q

Structurally, what part of the skin is afflicted in Erythema Nodosum?

A

Inflammation Deep into the fat layer

-results in the firm nodules

52
Q

Describe the category of pathology of Erythema Nodosum

A

-Panniculitis (inflammation of the subcutaneous fat)

53
Q

What kind of biopsy is needed for Erythema Nodosum?

A
  • Deep punch biopsy (Punch in a Punch biopsy)
  • Must get some SubQ fat

Note: We will see Granulomatous inflammation with Multinucleated Giant Cells

54
Q

What is the Rx for Erythema Nodosum?

A

Treat underlying disorder.

  • NSAIDS
  • Bed rest
55
Q

What is Herpes Zoster?

A
  • AKA Shingles
  • Recurrent infection with Vericella Zoster
  • Reactivation of latent virus in the sensory ganglia
  • Trunk Location
  • Dermatomal
56
Q

What type of person gets Herpes Zoster?

A
  • Elderly

- Immunocompromised

57
Q

Is Herpes Zoster contagious?

A
  • Can be but VERY rare.
  • Usually only Immunocompromised person

Herpes Zoster is a reactivation of VZV thus it is unlikely to develop zoster as a result of contact.

58
Q

What is the most common complication of Zoster?

A

Postherpetic Neuralgia

  • Pain that lasts after lesions hav healed
  • Lasts > 4 wks after onset of lesions.

Very painful

59
Q

What is the Rx for Herpes Zoster?

A

Symptomatic Treatment

  • Antihistamines
  • Analgesics
  • Cool Compress

If older than 50
-Systemic Antivirals (esp if lesions started within 72hrs ago)

60
Q

Hemorrhagic Crusting is classic for what condition?

A

Steven Johnson’s

61
Q

How is Steven Johnson’s different from TEN?

A

Body surface area afflicted.

-Less than 10% vs Greater than 30%

62
Q

What are some of the optical complications that can result from Steven Johnson’s Syndrome?

A

Due to mucosal and eye involvement:

  • Inflammation/fibrosis/scarring of the eyes
  • Even vision loss

Dermatology (7 decks)

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