Ermengecies Flashcards
what are the 3 main emergency categories
SJS/TEN
EM (erythema multiforme) major
and DRESS (eosinophilic drug reaction)
What is erythema multiforme major
Major vs minor-mucus membrane envolves
usually after infection (HSV or Mycoplasma)-after a pneumonia
rare case of reaction to drugs
Target lesions appear over 3-5 cays. annular lesion
Mucosal involvement-oropharynx, lips, genital
Fever, Myalgia, malaise
Possible unable to eat drink
Investigations and management of erythema multiforme major
Usually clinical diagnosis-the targets are quite specific
can do skin biopsy to confirm, or viral and wound swab
treat-self limiting over 4/6 weeks
+treat underlying (acyclovir/Abx)
supportive-Antihistamine, Topical steroids, mouth wash etc
eyes-need ophthalmology
IV fluids
oral steroids-unclear if help -dont use
What is SJS/TEN?
Stephen Johnson syndrome/Toxic Epidermal Necrolysis => they often overlap <10% surface are-SJS
10-30%-overlap
30%-TEN
Use SCORTEN criteria for prognosis
feel sick, fever, malaise, nearly sceptic
rash -epidermis lift -erosion few formed bullae mucosal involvement-eye/mouth can get target lesion (lot more unwell than EM major) Nikolski positive pain out of proportion to size
cause-drug reaction onset 2-3 weeks - Abx (40%), allopurinol, anticonvulsants, anti-retrovirals, -> started medication 1st time all age groups 100 more common with HIV
ANY PAINFUL ERYTHEMATOUS RASH WITH MUCOSAL INVOLVMENT
Investigation an Management of SJS/TEN
skin biopsy-want to check for pemphigoid/pemphigus
anaemia/lymphopenia, neutropenia, eosinophilia possible
Occasional renal changes
cultures to rule out any infections
treat-ITU/Burns unit and treat complications
Hypothermia, dehydration, Nutrition/NG, Aspirate fluid in bullae, Analgesics (not NSAID)
Abx -
can give IV immunoglobulin, also biologics available
then its a lot of dressings -parafin/vaseline, non adherent dressings
NOT steroids
what is DRESS?
Type of reaction to drugs-eosinophilia mediated +systemic symptoms
Delayed T cell mediated reaction
whole body rash, maculopapular (morbiliform)
Onset 2 to 8 weeks Fever Eryroderma facial swelling mucosal involvement rare lymphadenopathy
at least one other organ involved-heart/lungs/liver/kidney/joints/thyroid
Common medication - a lot of them
Investigations and Management of DRESS
Biopsy-eosinophils up
Look at organ involvement with bloods -heart/lungs/liver/kidney/joints/thyroid
Rule out Infection (bacteria and virus can also cause these rashes)
treat stop drugs supportive -emollients, antihistamines, etc Oral steroids also show good response Immunosuppresive therapy
What is erythroderma
rash of ANY kind, covering over 90% of the body area
often underlying cause, but not always
e.g.: eczema, psoriasis, dermatitis, AID, drug reaction, malignancy (esp heam),
can get full red body, itching, hair loss, onycholysis,
lymphadenopathy
scaly skin can occur 2-6 days
look at clues for underlying cause (like nails for psoriasis etc)
In older patients
and can easily kill -hypothermia, dehydration,
High output heart failure, skin infection, hypoalbuminia
Investigations and treatment of erythroderma
Skin biopsy-can pick up original diagnosis
full blood profile for complication and cause
Blood smear-sezary cells
cultures
then treat complications-
emollients, soap,
what is Eczema Herpeticum
Eczema + Herpes infection (HSV 1 or 2)
develop over 10 days present of hands/chest/face PMH of eczema Vesicule/punches out lesion all over painful, itchy, crusted
Fevers/malaise, lymphadenopathy
Very contagious
complication-oscular (always call ophtalm), lung, epiglottis, hepatitis, meningitis, encephalitis,
neuro and eye are mostcommon
Treat and investigations of Eczema herpeticu
Viral swabs
treat with oral acyclovir-400mg 5 times a day
patients very unwell to supportive
also secondary Abx for secondary bacterial Inf
steroids only after crusted over
what is necrotising fasciitis
Life threatening soft tissue infection-bacteria releasing toxin with necrosis tissue
spread from skin to Bone
B-heamolytic strep
Present with small patch (red/brown/purple/black) -extremely painful and quickly become sceptic and in shock
sick within 24h of onset
fever
most common in lower limbs
pain out of proportion to size
Investigations of necrotising fasciitis
FBC, renal, LFT, CRP
CK-msucle involvement
CT/MRI-gas In tissue
biopsy if doubt but treat before
treat-broad Abx and surgery-broad debridement of tissue
might need amputation
