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Year 4k: Dermatology > Emergency Dermatology > Flashcards

Emergency Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the essential management of all dermatological emergencies?

A
  • Full supportive care - ABC of resuscitation
  • Withdrawal of precipitating agents
  • Management of associated complications
  • Specific treatment (highlighted below under each condition)
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2
Q

What are causes of Urticaria, Angioedema and Anaphylaxis?

A
  • Idiopathic
  • Food (e.g. nuts, sesame seeds, shellfish, dairy products)
  • Drugs (e.g. penicillin, contrast media, non-steroidal anti- inflammatory drugs (NSAIDs), morphine, angiotensin-converting enzyme inhibitors (ACE-i))
  • Insect bites
  • Contact (e.g. latex)
  • Viral or parasitic infections
  • Autoimmune
  • Hereditary (in some cases of angioedema)
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3
Q

What causes Urticaria?

A
  • Urticaria is due to a local increase in permeability of capillaries and small venules.
  • A large number of inflammatory mediators (including prostaglandins, leukotrienes, and chemotactic factors) play a role but histamine derived from skin mast cells appears to be the major mediator.
  • Local mediator release from mast cells can be induced by immunological or non-immunological mechanisms.
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4
Q

What is the presentation of Urticaria and Angiodema?

A
  • Urticaria is a swelling involving the superficial dermis, raising the epidermis. Causes itchy wheals
  • Angioedema involves deeper swelling involving the dermis and subcutaneous tissues. Causes swelling of tongue and lips
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5
Q

How does anaphylaxis present?

A

Anaphylaxis (also known as anaphylactic shock):

  • Bronchospasm
  • Facial and laryngeal oedema
  • Hypotension
  • Can present initially with urticaria and angioedema
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6
Q

What is the management of Urticaria, Angioedema and Anaphylaxis?

A
  • Urticaria: Antihistamines
  • Severe acute urticaria and angioedema: Corticosteroids
  • Anaphylaxis: Adrenaline, corticosteroids and antihistamines
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7
Q

What is the definition and causes of Erythema Nodosum?

A

Hypersensitivity response to a variety of stimuli. Causes are:

  • Group A beta-haemolytic streptococcus
  • Primary tuberculosis
  • Pregnancy
  • Malignancy
  • Sarcoidosis
  • Inflammatory bowel disease (IBD)
  • Chlamydia
  • Leprosy
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8
Q

What is the presentation of Erythema Nodosum?

A
  • The shins are the most common site
  • Discrete tender nodules which may become confluent
  • Lesions continue to appear for 1-2 weeks and leave bruise-like discolouration as they resolve
  • Lesions do not ulcerate and resolve without atrophy or scarring
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9
Q

What is Erythema Multiforme?

A
  • Erythema multiforme, often of unknown cause, is an acute self- limiting inflammatory condition with herpes simplex virus being the main precipitating factor. Other infections and drugs are also causes.
  • Mucosal involvement is absent or limited to only one mucosal surface.
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10
Q

What is this?

A

Erythema Multiforme

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11
Q

What is this?

A

Stevens-Johnson syndrome

haracterised by
mucocutaneous necrosis with at least two mucosal sites involved. Skin involvement may be limited or extensive.

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12
Q

What is associated with Stevens-Johnson syndrome?

A

Drugs or combinations of infections or drugs are the main associations.

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13
Q

What is seen on histopathology for Stevens-Johnson syndrome?

A
  • Epithelial necrosis with few inflammatory cells is seen on histopathology.
  • The extensive necrosis distinguishes Stevens- Johnson syndrome from erythema multiforme.
  • Stevens-Johnson syndrome may have features overlapping with toxic epidermal necrolysis including a prodromal illness.
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14
Q

What is Toxic Epidermal Necrosis?

A
  • Toxic epidermal necrosis which is usually drug-induced, is an acute severe similar disease characterised by extensive skin and mucosal necrosis accompanied by systemic toxicity.
  • On histopathology there is full thickness epidermal necrosis with subepidermal detachment.
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15
Q

What is the management of Toxic Epidermal Necrosis?

A
  • Early recognition and call for help
  • Full supportive care to maintain haemodynamic equilibrium
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16
Q

What are complications of Erythema multiforme, Stevens-Johnson syndrome and Toxic epidermal necrolysis?

A
  • Mortality rates are 5-12% with SJS and >30% with TEN with death often due to:
    • Sepsis
    • Electrolyte imbalance
    • Multi-system organ failure
17
Q

What is Acute meningococcaemia?

A
  • A serious communicable infection transmitted via respiratory secretions; bacteria get into the circulating blood
  • Gram negative diplococcus - Neisseria meningitides
18
Q

What is the presentation of Acute Meningococcaemia?

A
  • Features of meningitis e.g. headache, fever, neck stiffness
  • Septicaemia e.g. hypotension, fever, myalgia
  • Non-blanching purpuric rash on the trunk and extremities, which may be preceded by a blanching maculopapular rash, and can rapidly progress to ecchymoses, haemorrhagic bullae and tissue necrosis
19
Q

What is the management of Acute Meningococcaemia?

A
  • Antibiotics (e.g. benzylpenicillin)
  • Prophylactic antibiotics (e.g. rifampicin) for close contacts (ideally within 14 days of exposure)
20
Q

What are complications of Acute meningococcaemia?

A
  • Septicaemic shock
  • Disseminated intravascular coagulation
  • Multi-organ failure
  • Death
21
Q

What is Erythroderma?

A

Exfoliative dermatitis involving at least 90% of the skin surface

Prognosis is largely depends on the underlying cause and overall mortality rate ranges from 20 to 40%

22
Q

What are causes of Erythroderma?

A
  • Previous skin disease (e.g. eczema, psoriasis)
  • Lymphoma,
  • Drugs (e.g.sulphonamides, gold, sulphonylureas, penicillin, allopurinol, captopril)
  • Idiopathic
23
Q

What is the presentation of Erythroderma?

A
  • Skin appears inflamed, oedematous and scaly
  • Systemically unwell with lymphadenopathy and malaise
24
Q

What is the management of Erythroderma?

A
25
Q

What are complications of Erythroderma?

A
  • Secondary infection
  • Fluid loss and electrolyte imbalance
  • Hypothermia
  • High-output cardiac failure
  • Capillary leak syndrome (most severe)
26
Q

What is this?

A

Erythroderma

27
Q

What is this?

A

Eczema herpeticum (Kaposi’s varicelliform eruption)

28
Q

What is Eczema herpeticum (Kaposi’s varicelliform eruption)?

A

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

  • Caused by Herpes Simplex virus
29
Q

How does Eczema herpeticum present (Kaposi’s varicelliform eruption)?

A
  • Extensive crusted papules, blisters and erosions
  • Systemically unwell with fever and malaise
30
Q

What is the management of Eczema herpeticum?

A
  • Antivirals (e.g. aciclovir)
  • Antibiotics for bacterial secondary infection
31
Q

What is the complications of Eczema Herpeticum?

A
  • Herpes hepatitis
  • Encephalitis
  • Disseminated intravascular coagulation (DIC)
  • Death rarely
32
Q

What is the Necrotising Fascitis?

A
  • Urgent referral for extensive surgical debridement
  • Intravenous antibiotics
33
Q

What are causes of Necrotising Fascitis?

A
  • Group A haemolytic streptococcus, or a mixture of anaerobic and aerobic bacteria
  • Risk factors include abdominal surgery and medical co-morbidities (e.g. diabetes, malignancy)
34
Q

What is the presentation for Necrotising Fascitis?

A
  • Severe pain
  • Erythematous, blistering, and necrotic skin
  • Systemically unwell with fever and tachycardia
  • Presence of crepitus (subcutaneous emphysema)
  • X-ray may show soft tissue gas (absence should not exclude the diagnosis)
35
Q

What is the management of Necrotising Fascistis?

A
  • Urgent referral for extensive surgical debridement
  • Intravenous antibiotics

Mortality up to 76%

Year 4k: Dermatology (9 decks)

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