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Dermatology > Emergency dermatology > Flashcards

Emergency dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the essential management of dermatological emergencies?

A

Full supportive care (A-E)
Withdrawal of precipitants
Management of associated complications
Specific treatment

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2
Q

What can cause urticaria/angioedema/anaphylaxis?

A 
Idiopathic
Food e.g. nuts, sesame, shellfish, dairy products
Contrast media
Drugs
-NSAIDs
-Morphine
-ACEi etc
Insect bites
Contact e.g. latex
Viral or parasitic infection
Autoimmune
Hereditary (some cases of angioedema)
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3
Q

What is urticaria?

A

Local increase in permeability of capillaries/small venules
Several inflammatory mediators (inc. prostaglandins, leukotrienes, chemotactic factors), esp histamine from skin mast cells are major mediators (may be induced by immunological and non-immunological mechanisms)

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4
Q

How does urticaria present?

A

Swelling of superficial dermis, raising epidermis

Itchy wheals

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5
Q

How does angioedema present?

A

Deeper swelling involving dermis and subcut tissues

Swelling of tongue and lips

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6
Q

How does anaphylactic shock present?

A

Bronchospasm
Facial and laryngeal oedema
HNT
May also present with urticaria and angioedema

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7
Q

What is the management for urticaria?

A

Antihistamine

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8
Q

What is the management for severe urticaria/angioedema?

A

Corticosteroids

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9
Q

What is the management of anaphylaxis?

A

Adrenaline
Corticosteroids
Antihistamines

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10
Q

What are the complications of

a) Urticaria?
b) angioedema/anaphylaxis?

A

a) normally uncomplicated

b) asphyxia, cardiac arrest, death

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11
Q

What is erythema nodosum?

A

Hypersensitivity response to variety of stimuli

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12
Q

What are the causes of erythema nodosum?

A 
Group A B-haemolytic strep
Primary TB
Pregnancy
Malignancy
Sarcoidosis
IBD
Chlamydia
Leprosy
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13
Q

How does erythema nodosum present?

A

Discrete tender nodules, may become confluent
Lesions continue to appear for 1-2w, leave bruise like discolouration as resolve
Lesions don’t ulcerate, resolve without atrophy or scarring
Shins most common site

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14
Q

What is erythema multiforme?

A

Acute, self-limiting inflammatory condition
Often of unknown cause but HSV often main precipitant (other infections and drugs are also causes)
Mucosal involvement absent or limited to just one mucosal surface

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15
Q

What is Stevens-Johnson syndrome?

A

Mucocutaneous necrosis with at least two mucosal sites involved (skin involvement may be limited or extensive)
Drugs/combinations of infections and drugs are main associations
Epithelial necrosis with few inflammatory cells seen on histopathology
Extensive necrosis distinguishes Stevens-Johnson from erythema multiforme
Stevens-Johnson may have features overlapping with toxic epidermal necrolysis, including prodromal illness

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16
Q

What is toxic epidermal necrosis?

A

Usually drug-induced
Acute severe disease characterised by extensive skin and mucosal necrosis with systemic toxicity
Histopath shows full thickness epidermal necrosis with subepidermal detachment

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17
Q

How are erythema multiforme/Stevens-Johnson/toxic epidermal necrosis managed?

A

Early recognition and call for help

Supportive care for haemostasis

18
Q

What complications are associated with erythema multiforme/Stevens-Johnson/toxic epidermal necrosis?

A

Mortality 5-12% with SJS and >30% with TEN

Death often due to sepsis, electrolyte imbalance, multi-system organ failure

19
Q

What is acute meningococcaemia?

A

Serious communicable infection transmitted via resp secretions; bacteria get into circulating blood

20
Q

What is the cause of acute meningococcaemia?

A

Gram negative diplococcus N. meningitides

21
Q

How does acute meningococcaemia present?

A 
Features of meningitis
-headache
-fever
-neck stiffness
Septicaemia
-hypotension
-fever
-myalgia
Typical non-blanching purpuric rash on trunk and extremities (possibly preceeded by blanching maculopapular rash), can rapidly progress to ecchymoses, haemorrhagic bullae and tissue necrosis
22
Q

How is acute meningococcaemia managed?

A

Abx e.g. benzylpenicillin

Prophylactic abx e.g. rifampicin, for close contacts (ideally within 14d)

23
Q

What complications are associated with acute meningococcaemia?

A

Septicaemic shock
DIC
Multi-organ failure
Death

24
Q

What is erythroderma?

A

Exfoliative dermatitis involving >90% skin surface

‘Red skin’

25
Q

What causes erythroderma?

A 
Previous skin disease 
-eczema
-psoriasis
Lymphoma
Drugs
-sulphonamides
-gold
-sulphonylureas
-penicillin
-allopurinol
-captopril
Idiopathic
26
Q

How does erythroderma present?

A

Inflammed, oedematous and scaly skin

Systemically unwell with lymphadenopathy and malaise

27
Q

How is erythroderma managed?

A

Treat underlying cause
Emollients and wet-wraps (maintain skin moisture)
Topical steroids may help relieve inflammation

28
Q

What are the complications associated with erythroderma?

A 
Secondary infection
Fluid loss and electrolyte imbalance
Hypothermia
High-output cardiac failure
Capillary leak syndrome (most severe)
29
Q

What is the prognosis for erythroderma?

A

Dependent on underlying cause

Mortality ranges from 20-40%

30
Q

What is eczema herpeticum?

A

Kaposi’s varicelliform eruption

Widespread eruption - serious complication of atopic eczema or less commonly other skin conditions

31
Q

What is the cause of eczema herpeticum?

A

HSV

32
Q

How does eczema herpeticum present?

A

Extensive crusted papules, blisters and erosions

Systemically unwell with fever and malaise

33
Q

How is eczema herpeticum managed?

A

Antivirals e.g. acyclovir

Abx for bacterial secondary infection

34
Q

What complications are associated with eczema herpeticum?

A

Herpes hepatitis
Encephalitis
DIC
Death (rarely)

35
Q

What is necrotising fasciitis?

A

Rapidly spreading infection of deep fascia with secondary tissue necrosis

36
Q

What causes necrotising fasciitis?

A

Group A haemolytic strep, or mixture of anaerobic and aerobic bacteria
50% cases occur in previously healthy individuals

37
Q

What are the risk factors for necrotising fasciitis?

A

Abdo surgery
Medical co-morbidities
-diabetes
-malignancy

38
Q

How does necrotising fasciitis present?

A

Severe pain
Erythematous, blistering, necrotic skin
Systemically unwell with fever and tachycardia
Presence of crepitus (subcutaneous emphysema)
X-ray may show soft tissue gas (absence should not exclude diagnosis)

39
Q

How is necrotising fasciitis managed?

A

Urgent referral for surgical debridement

IV abx

40
Q

What is the prognosis associated with necrotising fasciitis?

A

Mortality up to 75%

Dermatology (9 decks)

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