Drug-related and immune-mediated skin conditions Flashcards

1
Q

What life-threatening skin conditions are you aware of?

A

Infective:

  • necrotising fasciitis
  • Toxic shock syndrome

Drug-related:

  • SJS/TEN
  • DRESS syndrome (drug, rash, eosinophilia and systemic symptoms syndrome)

Immune-mediated:

  • Erythema multiform
  • Pemphigus vulgaris

Inflammatory:

  • acute generalised pustular psoriasis
  • erythroderma (exfoliative dermatitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Stevens-Johnson syndrome and toxic epidermal necrolysis?

A

SJS and TEN are a spectrum of acute severe, life-threatening skin reactions characterised by:

  • prodrome within 4-28 days of sore throat and fever
  • rash (macules followed by blistering)
  • mucocutaneous involvement and desquamation and necrosis
  • organ dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes of SJS/TEN?

A

Drugs:

  • sulphonamides and beta lactam abx
  • allopurinol, NSAIDs, anticonvulsants

Infection:

  • CMV
  • mycoplasma

Graft vs host disease:
- often severe and fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are SJS and TEN differentiated?

A

SJS <10% TBSA
TEN/SJS overlap 10-30% TBSA
TEN >30% TBSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the management of SJS TEN?

A
  • Removal of precipitant
  • supportive care (may develop MOF)
  • discuss with Burns centre
  • topical antiseptics
  • often IV steroids +/- IVIg +/- ciclosporin are used but not strong evidence of benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the mortality risk of SJS/TEN?

A

Up to 30% from drug related. Mortality very high in GvHD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the complications of SJS/TEN?

A
Septic shock
MOF
gastrointestinal perforation
renal failure
thromboembolic phenomena
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is DRESS syndrome?

A

Drug rash eosinophilia and systemic symptoms syndrome.
It is a severe life-threatening condition.
Caused by anticonvulsants and allopurinol most commonly. Other causes include NSAIDS, antimicrobials and antivirals.
Characterised by a longer latency period of 2-6 weeks and the morbilliform rash.
Most common extracutaneous involvement is lymphatics, and liver.
Has a mortality of around 10%.
Mx includes:
- removal of causative agent
- IV steroids
- supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of eosinophilia and rash?

A

CHINA

C - Connective tissue disease/Churg-strauss (EGPA)
H - Helminth infection
I - idiopathic
N - neoplastic (typically lymphoma)
A - Allergic reaction/Asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly