Emergency Dermatology Flashcards
57 male with known atopic eczema Difficult to manage lately Comes to A+E with red, painful skin Not slept in two nights Very sore all over Shivering Skin very dry and raw Temp 36.9C
Erythroderma - whole body erythema - sign of underlying problem e.g. Atopic eczema Prosiasis Pityriasis rubra pilaris Mycosis fungoides
Staph scalded skin syndrome
Staphylococcal exfoliative toxin
Antibiotics required, plus emolients, fluid replacement
- 5 year old with 2 days of cold symptoms
- Widespread itchy rash – mum noticed scratching
- Worse after coming out of the bath
- Individual lesions do not last more than a day
- Thought is was food allergy – cannot identify food triggers
Urticaria
•Mast cell degranulation
•50% cases are idiopathic
•Known triggers:
–External allergens (immediate type I reaction)
–Viral illnesses (children)
–Drugs (NSAIDS/Opioid analgesics)
–Cold (exercise/getting out of bath)
–Pressure (traumatic mast cell degranulation)
•Severity fluctuates with time
What 2 conditions cause oedematos swelling of lips and face, but in the more serious causes swelling of larynx and respiratory distress.
Angiodema and anaphylaxis
- 27 yo from Taiwan
- Started on carbamazapine 10 days ago for epilepsy
- Began to develop small ulcers in mouth
- Spots on skin
- Spots grew
- Skin now shedding in layers
- Very lethargic
- Difficulty in breathing
- Pulse high
- Blood pressure low
Toxic Epidermal Necrolysis
•Type IV (cell mediated) reaction to a drug
- Widespread epithelial shedding
- Respiratory mucosa may also be shed
- Nikolsky’s sign (image)
This, is a rare reaction to a drug and can progress to toxic epidermal necrolysis if not treated
Stevens Johnson Syndrome
Key first intervention in TEN / SJS?
Stop the offending drug!
- 72 yo comes in with collapse
- Ulcer also noted on medial left lower leg
- Been there for months
- Now discharging
- Patient has a temperature of 39.2C
Venous ulcer now infected - cellulitis
•Staphylococcus epidermidis/aureus
•Streptococcal spp. Also
•Treatment:
–Blood cultures and wound cultures
–Check heart sound (endocarditis)
–Flucloxacillin/Macrolide
2 year history
Systemically well
White cells normal
CRP normal
Apyrexic
Gravitational eczema
•Venous and Lymphatic compromise
•“All oedema is lymphoedema”-Peter Mortimer
•Treatment needs to be started early:
–Compression
–Elevation
–Mobility
–Moisturisers
•Often not primary concern
•Early intervention prevents late complications
- 52 with type II diabetes mellitus
- Very painful, tense swelling in leg
- Feels sick, shivery and sometimes delerious
- Hard, woody, purplish skin on leg
- Temperature 40.1C, low blood pressure, high heart rate
Necrotising Fasciitis
•Severe infection spreading along fascial planes
•High risk groups more common:
–People with diabetes
–IV drug abusers
–Immunocompromised
•Tissue necrosis causes multitude of environments
•Wide spectrum of bacteria
•Early recognition needed
Urgent surgical debridement and high dose antibiotics
- 27 had cold 2 weeks ago
- Came out in dotty non-blanching rash
- Some abdominal pain
- More spots on legs
- More as you go further down
- Otherwise feels well
- Rash is palpable
Post infective purpura
After infection - key to this is not systemically unwell, no signs of septicaemia
I think Sharrie had this
- 9 yo has had a cold for two days
- This evening has felt a lot worse and lethargic
- Mother noticed some pain on neck movements
- Intolerant of bright lights
- Mother noticed rash (not palpable) and not blanching
- Lethargic child, temp 39.1C
Meningococcal septicaemia until proven otherwise
- 24 yo has non blanching rash on legs
- Came on overnight
- No other problems
- Feels well in self
- Noticed gums bleeding when brushing teeth
- Non-palpable non-blanching rash on legs
- Platelets low (24)
- Otherwise well
Thrombotic thrombocytopaenic purpura
This autoimmune blistering disorder presents with usually intact blisters
Bullous pemphigoid
This autoimmune blistering disease presents with fragile blisters that burst easily
Pemphigus vulgaris
This autoimmune blistering disorder produces blisters on the extensor surfaces
Dermatitis herpetiformis
This is an infective blistering disorder involving exfoliative toxin
Bullous impetigo
