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Dermatology & Haematology > Emergency Dermatology & Infection > Flashcards

Emergency Dermatology & Infection Flashcards

1
Q

Which bugs commonly infect skin?

A 
Staph aureus
Strep pyogenes (and other strep)
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2
Q

You see a child with red, inflamed skin. There are large bullae, crusting round his mouth and he’s extremely distressed. His father says he was well yesterday.

What could it be?

A

Staphylococcal scaled skin syndrome

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3
Q

What age group is affected by Staphylococcal scaled skin syndrome?

A

Infants and early childhood

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4
Q

Pathophysiology of Staphylococcal scaled skin syndrome?

A

The bug: Benzylpenicillin resistant staphylococci

Produces a epidermolytic toxin which
**

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5
Q

Presentation of Staphylococcal scaled skin syndrome?

Specifically which bug causes it?

A

Develops within hours or days

Scalded appearance, large bullae, peri-orbital crusting

Severe pain

It’s benzylpenicillin resistant staphylococci

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6
Q

Management of Staphylococcal scaled skin syndrome?

A

Antibiotics: erythromycin, fusidic acid or cephalosporin

Supportive: fluids, analgesia

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7
Q

Which types of fungus cause skin infections? Give examples?

A

3 types:

  1. Dermatophytes: tinea, ringworm
  2. Yeasts: candidiasis
  3. Moulds: aspergillus
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8
Q

Which bit of the skin do fungi usually infect?

A

Superficial layers

Nails and hair

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9
Q

Where can tinea infect? How does each present?

A

T. corporis:

  • trunk and limbs
  • itchy annular lesions with raised scaly edge

T. cruris:

  • groin
  • as above

T. pedis:

  • athletes foot
  • moist scaling and fissuring in toewebs spreading to sole

T. manuum:

  • hands
  • scaling and dryness in palmar creases

T. capitis:

  • scalp
  • broken hair, scaling

T. unguium:

  • nail
  • yellow, crumbling, thickened nail
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10
Q

What is candidiasis?

A

Fungal infection of mucosal areas (mouth, vagina)

White patches, itchy and sore

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11
Q

A patient has scaly pale brown patches on their upper trunk. They’ve noticed these patches don’t tan. There’s no pain or itching. What could it be?

What bug?

A

Tinea versicolor

Fungus: Malassezia furfur

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12
Q

Management of fungal skin infections?

A

Treat precipitating factors, like immunosuppression, moist areas

Topical anti-fungals: clotrimazole

Oral anti-fungals for severe, widespread or nail infections
Terbinafine

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13
Q

Topical steroids are a good treatment for fungal infections. True or false?

A

False.

They can lead to tinea incognito, which is when lesions are better but still present because infection has not been treated.

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14
Q

What is urticaria?

Pathophysiology?

A

Swelling of superficial dermis, raising up the epidermis causing itchy wheals

Local increase in permeability of capillaries and small venules
Caused by histamine release by mast cells and other inflammatory mediators (prostaglandins, leukotrienes)

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15
Q

What is the difference between urticaria and angioedema?

A

Urticaria: swelling of superficial dermis which raises up the epidermis – wheals

Angioedema: swelling of deeper dermis and subcutaneous – tongue and lips

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16
Q

What is the relationship between urticaria + angioedema and anaphylaxis?

A

Often precedes anaphylaxis

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17
Q

Presentation of anaphylaxis?

A

Bronchospasm
Facial and laryngeal oedema
Hypotension

Features of urticaria and angioedema

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18
Q

Management of:

  • Urticaria
  • Angioedema
  • Anaphylaxis?
A

Urticaria: anti-histamines

Severe acute urticaria, angioedema: corticosteroids

Anaphylaxis: adrenaline, corticosteroids, anti-histamines

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19
Q

What are the complications of urticaria and angioedema?

A

Urticaria, not really any

Angioedema: can cause asphyxia, cardiac arrest, death

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20
Q

What things can cause urticaria, angioedema and anaphylaxis?

A

Food: nuts, shellfish, dairy

Drugs: penicillin, NSAIDs, morphine, ACEi

Insect bites

Autoimmune

Hereditary in some cases of angioedema

21
Q

A patient eats some peanuts for the first time. They come out in a rash. It’s discoid, raised and itchy. What is it?

22
Q

A patient eats some peanuts for the first time. Their lips swell up and they can’t speak properly. What is it?

A

Angioedema

23
Q

What is erythema nodosum?

A

A hypersensitivity response to a stimulus which results in a nodular rash

Such as:

  • Group A-haemolytic Strep
  • TB
  • Pregnancy
  • Malignancy
  • IBD
24
Q

Clinical features of erythema nodosum?

A

Discrete tender nodules

Nodules may become confluent

No ulceration and they resolve without scars

Commonly seen on shins

Continue to appear for 1-2 weeks

25
You see a patient with a discoid rash predominately on their lower legs. What might it be?
Urticaria: if it was itchy Erythema nodosum: if predominately on shins and non-itchy
26
Management of erythema nodosum?
Self-resolves
27
What is erythema multiforme?
Acute self-limiting inflammatory skin condition Precipitated by herpes simplex virus, or occasionally drugs and other infections Mucosal involvement limited to one mucosal surface
28
What is Stevens-Johnson syndrome?
Mucocutaneous necrosis with at least two mucosal sites involved Skin involvement can be limited or extensive Drugs + infections precipitate Extensive necrosis is seen
29
What is Toxic epidermal necrosis?
Acute severe disease Extensive skin and mucosal necrosis PLUS severe systemic toxicity
30
What are the differences in presentation of: - Erythema multiforme - S-J syndrome - Toxic epidermal necrosis?
EM: more on skin that mucosa, target lesions, and if mucosal involvement limited to one area, no systemic upset SJ: skin and mucosal inflammation and necrosis, but no systemic involvement TEN: skin and mucosal inflammation and necrosis, systemic toxicity
31
What are the differences histologically of: - S-J syndrome - Toxic epidermal necrosis?
SJ: epidermal epithelial necrosis + few inflammatory cells TEN: full thickness epidermidal necrosis and subepidermal detachement
32
What are the precipitating factors of: - Erythema multiforme - S-J syndrome - Toxic epidermal necrosis?
EM: commonly herpes simplex infection, but also drugs and other infections SJ: drugs and infections TEN: drugs
33
Management of: - Erythema multiforme - S-J syndrome - Toxic epidermal necrosis?
For all: Call for help from dermatology Supportive care: maintain haemodynamic equilibrium Monitor for bacterial infection and sepsis
34
Complications of: - Erythema multiforme - S-J syndrome - Toxic epidermal necrosis?
For all (but SJ and TEN more so) Sepsis Electrolyte imbalance Multi-system organ failure Death
35
Clinical features of erythroderma?
Exfoliative dermatitis Inflamed, oedematous, scaly skin Over 90% of body Systemically unwell Malaise Lymphadenopathy
36
Causes of erythroderma?
Previous skin disease: psoriasis, eczema Lymphoma Drugs: sulphonylureas, penicillin, allopurinol Idiopathic
37
Management of erythroderma?
Treat underlying cause if known Emollients and wet wraps to maintain moisture Topical steroids Supportive: fluids, analgesia Monitor for infection, sepsis
38
Complications of erythroderma?
Secondary infection Sepsis Fluid loss Electrolyte imbalance Hypothermia Cardiac failure due to high output Capillary leak syndrome ***
39
You see a patient with extensive inflammation and redness all over their body. There’s no mucosal involvement. Their skin is scaly and swollen. They feel unwell. What could they have?
Erythroderma
40
What is eczema herpeticum?
A serious complication of eczema (or rarely other skin diseases) The herpes simplex virus infects the eczema
41
Clinical features of eczema herpeticum?
Clinical features of eczema herpeticum? Widespread Extensive crusted papules, blisters, erosions Systemically unwell: fever, malaise
42
Management of eczema herpeticum?
Anti-virals Antibiotics if secondary bacterial infection
43
Complications of eczema herpeticum?
Herpes hepatitis Encephalitis DIC Death
44
What is necrotising fasciitis? Which bug?
Infection of deep fascia Rapidly spreading Often Group A haemolytic strep
45
Presentation of necrotising fasciitis?
Severe pain Erythematous, blistering, necrotic skin Systemically unwell: fever, tachycardia Crepitus (subcutaneous emphysema)
46
Management of necrotising fasciitis?
Urgent surgical debridement Antibiotics IV (BenPen + clind + gent) (also can use meropenem, tazocin)
47
Which bugs cause infective eczema?
Staph aureus, epidermidis Herpes simplex - Eczema herpeticum Strep pyogenes
48
What is the name for eczema infected with herpes simplex?
Eczema herpeticum

Dermatology & Haematology (8 decks)

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