Emergency Dermatology Flashcards
Examples of drug induced dermatology conditions
Maculopapular
Urticaria
Morbilliform
Paupulosquamous
Photo-toxi
Common drugs that cause dermatology problems
- Antibiotics
- NSAIDs
- Chemotherapeutic agents
- Psychotropic
- Anti-epileptic
- Cardiac
What type of condition is this?
Morbiliform rash
- refers to a rash that looks like measels.
- Conists of macular lesions that are red and usually 2-10mm in diameter but may be confluent in places
- flat, itchy with a history of a new drug
What type of condition is this?
Penicillin drug rash
- doesnt always indiciate a reaction
- nettle rash, slightly raised
- itchy and uncomfortable
What is this an example of?
Urticaria/angiooedema
- Excrutiatingly itch
- Intradermal fluid (so wont leak fluid)
- Hives
- airway compromise
What is this an example of?
Photo-toxic drug rash (bendroflumethiazide, wuinine)
- backs of hands not affected as have hardening of skin
- arms exposed to sunlight
What is this an example of?
Pustular drug rash from antibiotics
- think if recent drug history
- sterile - collection of acute inflammatory cells
What is this an example of?
Lichenoid rash
- looks similar to the rash “lichen planus”
- skin disease characterised by damage and infiltration between the dermis and epidermis
- purple skin rash
What is this an example of?
Vasculitis
- Triggers
- infection
- drugs
- connective tisue
- check for systemic vasculitis ie renal BP/urinalysis
- often localised and not rapidly progresive
- less unwell than in meningococcal rash- Palpable purpura, affects the lower areas
What is this an example of?
Psoriasiform rash
Psoriasis-like well demaracated pink erythema with scale
Sudden onset, no FHx
they arent known to have a psoriasis and have started a new drug!
Examples of acute blistering disorders
- Drug induced
- steven johnsons syndrome
- toxic epidermal necrolysis
- immunobullous disease
- bullous pemphigoid
- bullous pemphigus
What is this an example of?
Stevens johnson syndrome
- mucosal involvement!!! must
- mouth ulcers to haemorrhagic bleeding and blistering
What is this an example of?
Toxic epidermal necrolysis (TEN)
- Dermatological emergency
- Raw dermis!! whole epidermis has be sloughed off
- Majority drug induced
- Disease spectrum SJS TEN
- If < 10% skin involvement -SJS
- Most severe mucous membrane involvement
- Stop suspect drug
- Supportive, dressings, rarely immunosuppression
Treatment of TEN
- dermatological emergency
- in patient management Derm, ITU, burns
- analgesia
- fluid balance SCORTEN severity scale
- Special mattressm sheets
- infection control/prophylaxis
- non adherent dresings
- urology, gynae, opthalmology
- some reports >50% mortality
what is this an example of?
staphlococcal scalded skin syndrome
- confused with TEN
- staphylococcal skin infection
- young, otherwise fit
- no history of drugs
- treatment - Flucloxacillin
What is this an example of
- Self limiting immune reacion
- HSV, EBV, Ocasionaly drug
- no or mild prodrome
- target lesions - red ring, pale ring, then red ring in centre
- Never- TEN
Immunobullous disorders
Autoantibodes to various skin component ie BM proteins
- bullous pemphigoid - remember D means split is Deepe
- bullous pemphigus - remeber S means its superficial (cuboidal layer)
Where do you get dermatitis herpetiformis
Coeliac disease
elbows, knees and bum- specific distrubution
Test to test betwen immunobullous conditions
Immunoflourence
Which immunoobullous condition is this
Bullous pemphigoid
What immunobulloous condition is this?
Pemphigus
- no blistering
- superficial eruptions
- mouth and gentials involvement maybe
Treatment of immunibulllous disorders
- reduced autoimmune reaction- oral steroids
- steroid sparing agents ie azathioprine
- burst any blisters
- dressings and infection control
- check for oral/mucosal involvement
- consider screen for underlying malignancy
Urticaria
- Itchy, wheals (hives)
- Lesions last < 24 hours
- Non-scarring
- Commonest skin disorder to present A&E
- Acute < 6 weeks- immune mediated type 1 allergic IgE response
- Chronic > 6weeks- non-immune mediated direct mast cell degranulation (opiates, antibiotics, contrast media
- Treatment - antihistamines, steroids, immunosuppression, omiluzimab
Acute urticaria - causes
- unknown!!
- viral infections
- medications NSAIDS, apsiring
- foods and food additives - coloured fizzy drinks
- physical stimulants - cold, pressure, solar
Erythroderma
- descriptive term
- Let dermatologist know
- >80-90% involvement, ertyhema
- causes
- psoraisis
- eczema
- drug rashes
- treat underlying skin disorder, supportive
