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Year 3 - Dermatology > Emergency and Acute Dermatology > Flashcards

Emergency and Acute Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the major groups of acute skin reactions?

A 
Drug reactions
Toxic epidermal necrolysis
Stevens Johnson Syndrome
Erythema Multiforme 
Urticaria 
Vasculitis 
Erythroderma
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2
Q

What are the different types of skin drug reactions?

A 
Maculopapular
Urticaria
Morbilliform - looks like measles 
Papulosqaumous - looks liek psoriasis 
Photo-toxic - rash in the distribution of sun exposure
Pustular 
Lichenoid
Fixed drug rash
Bullous
Itch (no rash)
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3
Q

Which drugs most commonly cause acute skin changes?

A 
Antibiotics (penicillins, trimethoprim)
NSAIDs
Chemotherapeutic agents
Psychotropic - chlorpromazine 
Anti-epileptic - lamitrigine, carbamaz
Cardiac
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4
Q

Describe a morbilliform rash and common causes of it.

A 
Looks like measles
Blanches when you press on it
Macular - flat
Itchy
Often a reaction to penicillin
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5
Q

Describe a urticaric rash and common causes of it.

A 
(Hives)
Red
Raised bumps
Itchy/burning/stinging 
Angiooedema 
Often a reaction to ACE inhibitors
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6
Q

What is meant by a photo-toxic drug reaction?

A

Rash is caused by drugs but only appears after exposure to sunlight

  • quinine
  • bendroflumethiazide
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7
Q

Describe a pustular drug reaction.

A

Lots of pustules (inflamed, pus filled lumps) appear on the surface of the skin
Widespread (unlike acne)
Commonly caused by antibiotics

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8
Q

Describe a Lichenoid rash.

A

Looks similar to the Lichen planus rash

  • purple discolourations
  • itchy
  • fades to leave hyperpigmentation
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9
Q

What are some of the triggers of vasculitis?

A

Infection
Drugs
Connective tissue disease (e.g. RA)

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10
Q

How can you check for systemic vasculitis?

- not just the blood vessels and the skin that are inflamed

A

Renal blood pressure

Urinalysis

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11
Q

Given that a vasculitis rash looks like a meningococcal rash, how can you tell the difference between the two diseases?

A

The person is less systemically unwell in vasculitis

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12
Q

Describe a drug induced psoariasiform reacion.

A 
Psoriasis like rash
- well demarcated pink erythema
- hyperkeratosis
Sudden onset
No family history
Commonly on Lithium and beta-blockers
Foot is a common place
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13
Q

Describe a fixed drug reaction.

A

Exactly the same rash appears in exactly the same place every time the patient takes a specific drug
- paracetamol is common

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14
Q

Name two drug induced blistering disorders.

A

Steven Johnson Syndrome

Toxic epidermal necrolysis

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15
Q

Name two autoimmune blistering conditions.

A

Reaction to glue makeup that holds the skin toegther (this is destroyed so the skin splits and blisters)
Bullous pemphigoid
Bullous pemphigus

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16
Q

What is the most common clinical presentation of Steven Johnson Syndrome?

A

Mucositis - inflammation of the mucosa (lips and around the mouth)
If more than 10% of your skin is peeling, it’s probably not SJS (-> toxic epidermal necrolysis)

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17
Q

Why is Toxic Epidermal Necrolysis a dermatological emergency, and how is it delt with?

A 
50% mortality rate
- most severe mucous membrane involvement (>10% skin peeling)
- sudden onset 
- systemically ill 
Stop suspect drug
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18
Q

What does a positive Nikolsky’s sign indicate?

A

Nikolsky’s sign
- when slight rubbing of the skin causes the top layer to come off
Indicates TEN (toxic epidermal necrolysis)

19
Q

Describe the skin changes seen in toxic epidermal necrolysis.

A

Peeling skin
Flat red rash
Blisters and sores on the mucous membrane

20
Q

How is toxic epidermal necrolysis managed?

A 
Analgesia 
Fluid balance 
SCORTEN severity scale - risk of mortality
Treated like a burns patient
- Special mattress and sheets
- Infections control/prophylaxis
- Non adherent dressings
Urology, gynaecology and ophthalmology consults are required
- moisturisers
21
Q

Describe the appearance of staphylococcal scalded skin syndrome.

A 
Red blistering skin
- looks like a burn or a scald 
- blisters rupture easily 
Widespread
Tissue paper wrinkling of the skin
22
Q

What is staphylococcal scalded skin syndrome?

A

Common in children
Not as systemically unwell as TEN
Skin peels off as a result as a toxigenic Staph infection releases epidermolytic toxins A and B

23
Q

How is staphylococcal scalded skin syndrome treated?

A

With antibiotics (probably flucloxacillin)

24
Q

Describe the appearance of erythema multiforme.

A

Skin eruption characterised by a typical target lesion

  • round red/pink macules which become raised papules
  • gradually enlarge to form plaques up to 1cm in diamete
  • the centre may darken, blister and crust over
25
Q

What is the cause of erythema multiforme?

A

Self-limiting allergic reaction

  • often triggered by HSV or EBV
  • sometimes a drug trigger
26
Q

What symptoms indicate onset of erythema multiforme?

A 
None
Or mild
- fever
- chills
- weakness
- painful joints
27
Q

What are the difference between bullous pemphigoid and pemphigus skin blisters?

A

Pemphigoid
- deep split in the skin
Pemphigus
- superficial split in the skin

28
Q

Name the different types of pemphigoid blisters.

A

Bullous pemphigoid
Mucous membrane pemphigoid
Paraneoplastic pemphigoid

29
Q

What disease is dermatitis herpetiformis an indicator of?

A

Coeliac disease

30
Q

Describe the appearance of the skin in pemphigus.

A

Blistering is small and thin

- they slough off and turn into sores

31
Q

How are immunobullous disorders treated?

A 
Reducing the autoimmune reaction
-oral steroids
Steroid sparing immunosuppressants (azathioprine)
Burst blisters
Dressing and infection control
Check for oral/mucosal involvement 
Screen for underlying malignancy - rare
32
Q

How is dermatitis herpetiformis treated?

A

Topical steroids (dampens local immune response)
Gluten free diet
Oral dapsone

33
Q

Where does dermatitis herpetiformis normally appear?

A

Elbows
Knees
Bottom

34
Q

What is the most common skin disorder to present to A&E?

A

Uritcaria

35
Q

Describe the skin changes seen in Urticaria.

A 
Itchy wheals (hives)
- raised patches of skin (oedmea)
Scratch marks 
Lesions last less than 24 hours
Non-scarring
36
Q

What are the time frames for acute and chronic urticaria?

A

Acute - if it goes away after less than 6 weeks

Chronic - if it is still present for more than 6 weeks

37
Q

What is the cause of urticaria?

A 
Immune mediated type 1 allergic IgE response 
- doesn't quite progress to anaphylaxis
Non-immune mediated
- direct mast cell degranulation
- e.g. opiates, contrast media, NSAIDs
38
Q

How is urticaria treated?

A

Antihistamines - high doses
Steroids
Immunosuppression
Omiluzimab - anti IgE drug

39
Q

Name some causes of acute urticaria.

A

Viral infections
Medications - NSAIDs, aspirin, ACE inhibitors
Food and food additives
Parasitic infections
Physical stimulants
- cold, pressure, solar, cholingeric, aquagenic

40
Q

What is pressure urticaria?

A

Urticaria that is elciated by pressing down on the skin
- Dermographism
Wheal and flare reaction

41
Q

Describe the skin changes seen in erythroderma.

A

Not a condition, just a description of the skin

- red skin from head to toe (80-90% of surface area)

42
Q

What are the most common causes of erythroderma?

A

Psoriasis
Eczema
Drug reaction
Cutaneous lymphoma - rare

43
Q

How is erythroderma treated?

A

Treat the underlying skin disorder
Supportive
- fluid and temperature balance
- moisturisers

Year 3 - Dermatology (6 decks)

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