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Mariam Dermatology > Lecture 6: Acute and Emergency Dermatology > Flashcards

Lecture 6: Acute and Emergency Dermatology Flashcards

1
Q

What is erythoderma

A

Any inflammatory skin disease affecting > 90% of the total skin surface

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2
Q

Causes of Erythoderma

A 
Psoraisis
Ezcema
Drugs
Cutaneous Lymphoma
Hereditary disorders
Idiopathic/unknown
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3
Q

Management of erythoderma

A 
Fluid balance
Good nutrition- protein
Removal of offending drugs
Temperature regulation
Emollients
Oral/eye care
Treat underlying cause
Anticipate or treat any infection
Manage itch
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4
Q

Severe consequences of skin drug reactions

A

Stevens Johnsons Syndrome & Toxic Epidermal Necrolysis

Epidermal detachment

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5
Q

Differences between Stevens Johnsons Syndrome & Toxic Epidermal Necrolysis

A

SJS < 10% epidermal detachment

SJS-TEN Overlap 10-30%

TEN > 30%

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6
Q

Clinical features of Stever Johnsons Syndrome

A 
Fever
Malaise
Arthralgia- pain in joints
Rash- maculopapular, target lesions, blisters
Mouth ulceration- Greyish white membrane
Hemorrhagic crusting 
Ulceration of other mucous membranes
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7
Q

Difference between SJS/TEN and Erythema Multiforme

A

Erythema Multiforme- hypersensitivity reaction usually triggered by a viral infection
Do much better the SJS/TEN and is often self-limiting

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8
Q

What is Drug reaction with Eosinophilia and Systemic Symptoms (DRESS)

A

Drug reaction 2-8 weeks after exposure

Signs:

  • Widespread rash, blistering
  • Fever
  • Eosinophilia and deranged liver function
  • Lymphadenopathy
  • Other organ involvement
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9
Q

Treatment for DRESS

A

Stop the drugs
Systemic steroids
Immunotherapy

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10
Q

What is Pempigus

A

Antibodies attacking the dermasomes in the skin (mucous membrane) causing painful blisters in the skin

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11
Q

Clinical features of pempigus

A

Superficial
Flaccid blisters that can easily rupture
Ill defined erroisions
Positive Nikolsky’s sign (top layer of skin peels off)

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12
Q

Common sites of pempigus

A 
Face
Axilla
Groin
Eyes
Nose
Genital areas
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13
Q

What is Pempigoid

A

Antibodies directed at dermo-epidermal junction in the skin

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14
Q

Clinical features of pempigoid

A

Intact epidermis forms roof of tense blisters

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15
Q

Difference between pempigus and pempigoid

A

Pempigus:

  • Uncommon
  • Middle age patients
  • Fragile blisters
  • Mucous membrane usually affected
  • Patients may be very unwell if extensive
  • Treatment: systemic steroids

Pempigoid:

  • Common
  • Usually elderly patients
  • Blisters are intact and tense
  • Even if extensive, patient may not have any systemic symptoms
  • Topical steroids
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16
Q

What is erythrodermic psoriasis and pustular psoriasis

A

Sign of unstable psoriasis which can be caused by an infection (strep throat) or sudden withdrawal of steroids

17
Q

Clinical features of erythrodermic psoriasis and pustular psoriasis

A

Fever
Elevated WCC
Can progress to generalised erythema with/without clusters of pustules

18
Q

What is eczema herperticum

A

Herpes virus + uncontrolled eczema

19
Q

Clinical features of eczema herperticum

A

Monomorphic blisters and punched out erosions
Painful & itchy
Lethargy

20
Q

Treatment of eczema herperticum

A

Aciclovir

Topical steroids

21
Q

What is staphylococcal scalded skin syndrome

A

Erythematous rash with skin tenderness following Staph infection

Due to bacteria producing toxins which targets desmoglein 1 (protein which maintains the adhesion of the skin surface)

Common in children and immunocompromised adults

22
Q

Clinical features of Staphylococcal Scalded Skin Syndrome

A
  • Diffuse erythematous rash with skin tenderness
  • More prominent in flexures
  • Blistering and desquamation
  • Fever & irritability
23
Q

Treatment for Staphylococcal Scalded Skin reaction

A

IV Antibiotics

24
Q

What is utricia

A

AKA hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly – either as a result of the body’s reaction to certain allergens, or for unknown reasons

25
Q

Pathophysiology of utricia

A

Histamine released into the dermis

Angioedema- causes deeper swelling of skin

26
Q

Causes of acute utricia ( < 6 weeks)

A

Idiopathic - 50%
Infection (usually viral)- 40%
Drugs, IgE mediated reaction- 9%
Food, IgE mediated- 1%

27
Q

Management of acute utricia

A 
Oral antihistamines ( up to 4x dose)
Steroids
Avoid opioids and NSAIDs as they exacerbate utricia
28
Q

Causes of chronic utricia (> 6 weeks)

A
  • Autoimmune /idiopathic - 60%
  • Physical trauma - 35%
  • Vasculitic- 5%
29
Q

Management of chronic utricia

A

Step 1: Standard dose of non-sedating antihistamines
Step 2: Higher dose of antihistamines
Step 3: Consider an anti-leukotriene/if angioedema is present us tranexamic acid
Step 4: Immunomodulant such as omalizumab

Mariam Dermatology (10 decks)

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