Emergency Dermatology Flashcards
Examples of drug induced dermatology conditions
Maculopapular
Urticaria
Morbilliform
Paupulosquamous
Photo-toxi
Common drugs that cause dermatology problems
- Antibiotics
- NSAIDs
- Chemotherapeutic agents
- Psychotropic
- Anti-epileptic
- Cardiac
What type of condition is this?
Morbiliform rash
- refers to a rash that looks like measels.
- Conists of macular lesions that are red and usually 2-10mm in diameter but may be confluent in places
- flat, itchy with a history of a new drug
What type of condition is this?
Penicillin drug rash
- doesnt always indiciate a reaction
- nettle rash, slightly raised
- itchy and uncomfortable
What is this an example of?
Urticaria/angiooedema
- Excrutiatingly itch
- Intradermal fluid (so wont leak fluid)
- Hives
- airway compromise
What is this an example of?
Photo-toxic drug rash (bendroflumethiazide, wuinine)
- backs of hands not affected as have hardening of skin
- arms exposed to sunlight
What is this an example of?
Pustular drug rash from antibiotics
- think if recent drug history
- sterile - collection of acute inflammatory cells
What is this an example of?
Lichenoid rash
- looks similar to the rash “lichen planus”
- skin disease characterised by damage and infiltration between the dermis and epidermis
- purple skin rash
What is this an example of?
Vasculitis
- Triggers
- infection
- drugs
- connective tisue
- check for systemic vasculitis ie renal BP/urinalysis
- often localised and not rapidly progresive
- less unwell than in meningococcal rash- Palpable purpura, affects the lower areas
What is this an example of?
Psoriasiform rash
Psoriasis-like well demaracated pink erythema with scale
Sudden onset, no FHx
they arent known to have a psoriasis and have started a new drug!
Examples of acute blistering disorders
- Drug induced
- steven johnsons syndrome
- toxic epidermal necrolysis
- immunobullous disease
- bullous pemphigoid
- bullous pemphigus
What is this an example of?
Stevens johnson syndrome
- mucosal involvement!!! must
- mouth ulcers to haemorrhagic bleeding and blistering
What is this an example of?
Toxic epidermal necrolysis (TEN)
- Dermatological emergency
- Raw dermis!! whole epidermis has be sloughed off
- Majority drug induced
- Disease spectrum SJS TEN
- If < 10% skin involvement -SJS
- Most severe mucous membrane involvement
- Stop suspect drug
- Supportive, dressings, rarely immunosuppression
Treatment of TEN
- dermatological emergency
- in patient management Derm, ITU, burns
- analgesia
- fluid balance SCORTEN severity scale
- Special mattressm sheets
- infection control/prophylaxis
- non adherent dresings
- urology, gynae, opthalmology
- some reports >50% mortality
what is this an example of?
staphlococcal scalded skin syndrome
- confused with TEN
- staphylococcal skin infection
- young, otherwise fit
- no history of drugs
- treatment - Flucloxacillin
What is this an example of
- Self limiting immune reacion
- HSV, EBV, Ocasionaly drug
- no or mild prodrome
- target lesions - red ring, pale ring, then red ring in centre
- Never- TEN
Which immunoobullous condition is this
Bullous pemphigoid
What immunobulloous condition is this?
Pemphigus
- no blistering
- superficial eruptions
- mouth and gentials involvement maybe
