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Neurology and Special Senses > Emergency Dermatology > Flashcards

Emergency Dermatology Flashcards

1
Q

What does the essential management for dermatological emergencies consist of?

A

Full supportive care
Withdrawal of precipitant agents
Manage complications
Specific treatment

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2
Q

What dermatological conditions can be life threatening?

A 
Urticaria, anaphylaxis and angioedema
Erythema nodosum
Erythema multiforme
Toxic epidermal necrolysis
Stevens-Johnson syndrome
Acute meningoccaemia
Erythroderma
Eczema herpeticum
Necrotising fasciitis
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3
Q

What can cause anaphylaxis?

A 
Food - nuts, seeds, shellfish
Drugs - ACE-Inhibitors, NSAIDS, Morphine etc
Insect bites
Contact - latex
Viral/parasitic infections
Autoimmune
Hereditary
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4
Q

How does urticaria present?

A

Swelling involving the superficial dermis

Itchy wheals

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5
Q

How does angioedema present?

A

Deeper swelling involving dermis and subcutaneous tissue

Swelling of lips and tongue

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6
Q

How does anaphylaxis present?

A

Bronchospasms
Facial and laryngeal oedema
Hypotension

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7
Q

How is urticaria managed?

A

Antihistamines

Corticosteroids if severe

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8
Q

How is angioedema managed?

A

Corticosteroids

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9
Q

How is anaphylaxis managed?

A

Adrenaline - 0.5mg IM (repeat every 5 mins)
Corticosteroids - 200mg IV hydrocortisone
Antihistamines - 10mg IV Chlorphenamine

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10
Q

What are some complications of angioedema and anaphylaxis?

A

Asphyxia
Cardiac arrest
Death

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11
Q

What is erythema nodosum?

A

Hypersensitivity response to a variety of stimuli

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12
Q

What causes erythema nodosum?

A 
Group A Beta Haemolytic strep
Primary tuberculosis
Pregnancy
Malignancy
Sarcoidosis
IBD
Chlamydia
Leprosy
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13
Q

How does erythema nodosum present?

A

Discrete tender nodules which may become confluent

Appear for 1-2 weeks then leave bruise like discolouration as resolve

Mostly shins

No ulceration, atrophy or scarring

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14
Q

How is erythema nodosum managed?

A

Treat the cause

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15
Q

What is erythema multiforme?

A

Acute self limiting inflammatory condition

Target lesions are seen on the back of the hands/feet before spreading to the torso

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16
Q

What precipitates erythema multiforme?

A

Mostly herpes simplex virus

Also caused by other infections and drugs

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17
Q

What is Stevens-Johnson syndrome (SJS)?

A

Mucocutaneous necrosis with at least 2 mucosal sites involved

Associated with drugs and infections

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18
Q

What distinguishes Stevens-Johnson syndrome from erythema multiforme?

A

Extensive epithelial necrosis with few inflammatory cells

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19
Q

What is toxic epidermal necrosis (TEN)?

A

Extensive skin and mucosal necrosis associated with systemic toxicity

20
Q

How is toxic epidermal necrosis different from Stevens-Johnson Syndrome?

A

Full thickness epidermal necrosis with subepidermal detachment is seen on histopathology

21
Q

How are SJS, TEN and erythema multiforme managed?

A

Full supportive care to maintain haemodynamic equilibrium

22
Q

What are the main complications of SJS and TEN?

A

SJS 5-12% mortality
TEN >30% mortality

Mortality often due to sepsis, electrolyte imbalance or multiple system organ failure

23
Q

What is acute meningococcaemia?

A

A serious communicable infection transmitted via respiratory secretions

24
Q

What causes acute meningococcaemia?

A

Neisseria Meningitides

25
Q

How does acute meningococcaemia present?

A

Meningitis features - headache, fever, neck stiffness, photophobia

Septicaemia - hypotension, fever, myalgia

Rash - non blanching purpuric rash on trunk and extremities

26
Q

What precedes a meningococcal rash and how can it progress?

A

Preceded - blanching maculopapular rash

Progress - ecchymoses, haemorrhagic bullae and tissue necrosis

27
Q

How is acute meningococcaemia managed?

A

Antibiotics - benpen

Prohylactic antibiotics for close contacts - Rifampicin ideally within 14 days of exposure

28
Q

What are the complications of acute meningococcaemia?

A

Septicaemic shock
DIC
Multi-organ failure
Death

29
Q

What is erythroderma?

A

Exfoliative dermatitis involving at least 90% of the skin surface

30
Q

What causes erythroderma?

A

Previous skin disease - eczema, psoriasis
Lymphoma
Drugs - sulphonamides, gold, sulphonylureas. penicillin
Idiopathic

31
Q

How does erythroderma present?

A

Inflamed, oedematous scaly skin

Systemically unwell - lymphadenopathy and malaise

32
Q

How is erythroderma managed?

A

Treat underlying cause
Emollients and wet-wraps - maintain skin moisture
Topical steroids - inflammation

33
Q

What are the complications of erythroderma?

A 
Secondary infection
Fluid loss
Electrolyte imbalance
Hypothermia
High-output cardiac failure
Capillary leak syndrome
34
Q

What is the prognosis for erythroderma?

A

Depends on underlying cause

20-40% mortality

35
Q

What is eczema herpeticum?

A

Severe primary infection of the skin by herpes simplex virus 1 or 2

36
Q

How does eczema herpeticum present?

A

Commonly patients have atopic eczema

Extensive crusted papules, blisters and erosions
Systemically unwell with fever and malaise

37
Q

How is eczema herpeticum managed?

A

Antivirals - IV Aciclovir

Antibioitcs for bacterial secondary infection

38
Q

What are the complications of eczema herpeticum?

A

Herpes hepatitis
Encephalitis
DIC
Death (rare)

39
Q

What is necrotising fasciitis?

A

Rapidly spreading infection of the deep fascia with secondary necrosis

40
Q

What causes necrotising fasciitis?

A

Group A haemolytic strep

Mix of anaerobic and aerobic bacteria

41
Q

What are some risk factors for necrotising fasciitis?

A

Abdominal surgery
Diabetes
Malignancy

42
Q

How does necrotising fasciitis present?

A

Severe pain
Erythematous, blistering necrotic skin
Systemically unwell - fever and tachycardia
Crepitus - subcutaneous emphysema

43
Q

What can be seen on X-Ray with necrotising fasciitis?

A

Soft tissue gas

44
Q

How is necrotising fasciitis managed?

A

Extensive surgical debridement

IV antibiotics

45
Q

What is the prognosis for necrotising fasciitis?

A

Upto 76% mortality

Neurology and Special Senses (28 decks)

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