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
