Emergency Dermatology Flashcards

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1
Q

Examples of drug induced dermatology conditions

A

Maculopapular
Urticaria
Morbilliform
Paupulosquamous
Photo-toxi

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2
Q

Common drugs that cause dermatology problems

A
  • Antibiotics
  • NSAIDs
  • Chemotherapeutic agents
  • Psychotropic
  • Anti-epileptic
  • Cardiac
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3
Q

What type of condition is this?

A

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
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4
Q

What type of condition is this?

A

Penicillin drug rash

  • doesnt always indiciate a reaction
  • nettle rash, slightly raised
  • itchy and uncomfortable
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5
Q

What is this an example of?

A

Urticaria/angiooedema

  • Excrutiatingly itch
  • Intradermal fluid (so wont leak fluid)
  • Hives
  • airway compromise
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6
Q

What is this an example of?

A

Photo-toxic drug rash (bendroflumethiazide, wuinine)

  • backs of hands not affected as have hardening of skin
  • arms exposed to sunlight
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7
Q

What is this an example of?

A

Pustular drug rash from antibiotics

  • think if recent drug history
  • sterile - collection of acute inflammatory cells
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8
Q

What is this an example of?

A

Lichenoid rash

  • looks similar to the rash “lichen planus”
  • skin disease characterised by damage and infiltration between the dermis and epidermis
  • purple skin rash
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9
Q

What is this an example of?

A

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
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10
Q

What is this an example of?

A

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!

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11
Q

Examples of acute blistering disorders

A
  • Drug induced
    • steven johnsons syndrome
    • toxic epidermal necrolysis
  • immunobullous disease
    • bullous pemphigoid
    • bullous pemphigus
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12
Q

What is this an example of?

A

Stevens johnson syndrome

  • mucosal involvement!!! must
  • mouth ulcers to haemorrhagic bleeding and blistering
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13
Q

What is this an example of?

A

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
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14
Q

Treatment of TEN

A
  • 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
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15
Q

what is this an example of?

A

staphlococcal scalded skin syndrome

  • confused with TEN
  • staphylococcal skin infection
  • young, otherwise fit
  • no history of drugs
  • treatment - Flucloxacillin
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16
Q

What is this an example of

A
  • 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
17
Q

Immunobullous disorders

A

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)
18
Q

Where do you get dermatitis herpetiformis

A

Coeliac disease

elbows, knees and bum- specific distrubution

19
Q

Test to test betwen immunobullous conditions

A

Immunoflourence

20
Q

Which immunoobullous condition is this

A

Bullous pemphigoid

21
Q

What immunobulloous condition is this?

A

Pemphigus

  • no blistering
  • superficial eruptions
  • mouth and gentials involvement maybe
22
Q

Treatment of immunibulllous disorders

A
  • 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
23
Q

Urticaria

A
  • 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
24
Q

Acute urticaria - causes

A
  • unknown!!
  • viral infections
  • medications NSAIDS, apsiring
  • foods and food additives - coloured fizzy drinks
  • physical stimulants - cold, pressure, solar
25
Q

Erythroderma

A
  • descriptive term
  • Let dermatologist know
  • >80-90% involvement, ertyhema
  • causes
    • psoraisis
    • eczema
    • drug rashes
  • treat underlying skin disorder, supportive