Emergency Dermatology

Question 1

What is SJS

Answer 1

A disproportional immune response causes epidermal necrosis resulting in blistering and shedding of the top layer of skin.

Question 2

What is Toxic Epidermal Necrolysis (TEN)

Answer 2

Same as SJS but it affects more than 10% body surface area

Question 3

Who is more at risk of SJS and TEN

Answer 3

Certain HLA genetic types

Question 4

Medication causes of SJS and TEN

Answer 4

Anti-epileptics, antibiotics, allopurinol and NSAIDs

Question 5

Infections causing SJS or TEN

Answer 5

Herpes simplex, mycoplasma pneumonia, CMV, HIV

Question 6

Presentation of SJS or TEN

Answer 6

Usually starts with non-specific symptoms of fever, cough, sore throat, sore eyes and ichy skin. Then a purple or red rash develops across skin and blisters.

Question 7

What after a few days after the blistering starts

Answer 7

Skin starts to break away and shed leaving the raw tissue underneath. Pain, erythema, blistering and shedding can also happen to lips and mucous membranes.

Question 8

Management of SJS and TEN

Answer 8

Admitted and given nutritional care, antiseptics, analgesia and ophthalmology input.

Question 9

Treatment options for SJS or TEN

Answer 9

Steroids, immunoglobulins, immunosuppressant medications

Question 10

Complications of SJS and TEN

Answer 10

Secondary infections, permanent skin damage and visual complications

Question 11

What is eczema herpeticum

Answer 11

Disseminated HSV infection due to impaired skin protection as a result of atopic dermatitis

Question 12

Presentation of eczema herpeticum

Answer 12

Monomorphic vesicular rash which can ulcerate and crust. Can be systemic effects

Question 13

Diagnosis of eczema herpeticum

Answer 13

Swab and Tzanck test

Question 14

Treatment of eczema herpeticum

Answer 14

IV aciclovir

Question 15

What is necrotising fasciitis

Answer 15

Infection of subcuntaneous soft tissue, with spread along fascial planes but not underlying muscle

Question 16

Presentation of necrotising fascitis

Answer 16

Rapidly spreading cellulitis and are systemically very unwell. History of risk factors.

Question 17

Examination of skin in necrotising fascitis

Answer 17

Affected region will be blistering, and erythematous. Mild oedema in early stages. Severe pain or aneasthesia over cellulitis site. Skin may go grey with overlying crepitus in advanced cases

Question 18

Management of necrotising fasciitis

Answer 18

Haemodynamic support, urgent debridement surgery, broad spec antibiotics.

Question 19

What is erythroderma

Answer 19

Dermatological emergency where there is widespread erythema affecting >90% of skin surface.

Question 20

What can erythroderma result in

Answer 20

Head and fluid loss, causing hypothermia and systemic symptoms

Question 21

Most common cause of erythroderma

Answer 21

Exacerbation of pre-existing skin conditions - dermatitis, psoriasis, pityriasis rubra pilaris

Question 22

Other causes of erythroderma

Answer 22

Drug allergies, idiopathic, sezary syndrome (form of cutaneous T-cell lymphoma)

Question 23

Management of erythroderma

Answer 23

Supportively with fluids,emollients and by treating underlying disease

Question 24

What is erythema nodusum

Answer 24

Hypersensitivity reaction to variety of stimuli

Question 25

Causes of erythema nodusum

Answer 25

Group A beta-haemolytic strep, primary TB, pregnancy, malignancy, sarcoidosis, IBD, chlamydia and leprosy

Question 26

Presentation of erythem nodusum

Answer 26

Discrete tender nodules which become confluent

Question 27

Most common site for erythema nodusum

Answer 27

Shins

Question 28

Time course of erythema nodusum

Answer 28

Continue to appear for 1-2 weeks and leave bruise like discolouration as they resolve

Question 29

Presentation of SJS

Answer 29

Mucocutaneous necrosis with at least 2 mucosal sites involved

Question 30

Main associations with SJS

Answer 30

Drugs or combinations of drugs and infections

Question 31

Main causes of TEN

Answer 31

Usually drug induced