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Derm yan > Acute and Emergency Dermatology > Flashcards

Acute and Emergency Dermatology Flashcards

1
Q

What is the largest organ in the body?

A

Skin

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2
Q

Consequences of skin failure relates to function, what does failure of the skin to be a mechanical barrier to infection cause?

A

Sepsis

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3
Q

Consequences of skin failure relates to function, what does failure of temperature regulation cause?

A

Hypo or hyper-thermia

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4
Q

Consequences of skin failure relates to function, what does failure of the skin to balance fluid and electrolytes lead to?

A

Protein and fluid loss

Renal impairment

Peripheral vasodilation

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5
Q

What is erythroderma?

A

Descriptive term rather than a diagnosis:

  • “Any inflammatory skin disease affecting >90% of the total skin surface”
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6
Q

What are some causes of erthroderma?

A
  • Psoriasis
  • Eczema
  • Drugs
  • Cutaneous lymphoma
  • Hereditary disorders
  • Unknown
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7
Q

What are the principles of erythroderma management?

A
  • Remove any offending drugs
  • Fluid balance
  • Good nutrition
  • Temperature regulation
  • Oral and eye care
  • Anticipate and treat infection
  • Manage itch
  • Disease specific therapy, treat underlying cause
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8
Q

What is an example of a mild drug reaction?

A

Morbiliform exanthema

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9
Q

What is morbiliform exanthema?

A

Rose-red flat (macular) or slightly elevated (maculopapular) eruption, showing circular or elliptical lesions varying in diameter from 1 to 3 mm, with healthy-looking skin intervening

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10
Q

What are examples of severe drug reactions?

A
  • Erthroderma
  • Stevens Johnson Syndrome (SJS)
  • Toxic epidermal necrolysis (TEN)
  • DRESS
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11
Q

What does SJS stand for?

A

Stevens Johnson Syndrome

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12
Q

What does TEN stand for?

A

Toxic epidermal necrolysis

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13
Q

What drugs can SJS or TEN be secondary to?

A
  • Antibiotics
  • Anticonvulsants
  • Allopurinol
  • NSAIDs
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14
Q

What percentage of epidermal detachment occurs with SJS?

A

<10%

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15
Q

What percentage of epidermal detachment occurs with TEN?

A

30%

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16
Q

Which of SJS and TEN affects a larger surface area?

A

TEN

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17
Q

What are the clinical features of SJS?

A
  • Fatigue, malaise, arthralgia (pain in a joint)
  • Rash
    • Maculopapular, target lesions, blisters
    • Erosions covering <10% of skin surface
  • Mouth ulceration
    • Greyish white membrane
    • Haemorrhagic crustings
  • Ulceration of other mucous membranes
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18
Q

What are the clinical features of TEN?

A
  • Often presents with prodromal febrile illness
  • Ulceration of mucous membranes
  • Rash
    • May start as macular, purpuric or blistering
    • Rapidly becomes confluent
    • Nikolsky’s sign may be positive
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19
Q

What is the management of SJS/TEN?

A
  • Identify and stop culprit drug as soon as possible
  • Supportive therapy
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20
Q

What is the prognosis of SJS/TEN?

A

SJS - 10% mortality

TEN - 30% mortality

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21
Q

What scale is used to determine how severe SJS or TEN are?

A

SCORTEN

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22
Q

What does a greater SCORTEN score increase?

A

Mortality

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23
Q

What does SCORTEN scale consider?

A
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24
Q

What are some long term complications of SJS/TEN?

A
  • Pigmentary skin changes
  • Scarring
  • Eye disease and blindness
  • Nail and hair loss
  • Joint contractures
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25
Q

What is erythema multiforme?

A

Hypersensitivity reaction usually triggered by infection

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26
Q

What infections is erthema multiforme most commonly associated with?

A

HSV then myoplasma pneumonia

27
Q

What is the clinical presentation of erythema multiforme?

A

Abrupt onset of up to 100s of lesions over 24 hours:

  • Distal to proximal
  • Palms and soles
  • Mucosal surfaces
  • Evolve over 72 hours
    • Pink macules, become elevated and may blister
28
Q

What is the treatment for erythema multiforme?

A

Self limiting and resolves over 2 weeks

Symptomatic and treat underlying cause

29
Q

What does DRESS stand for?

A

Drug reaction with eosinophilia and systemic symptoms

30
Q

What is the mortality of DRESS?

A

Up to 10%

31
Q

When does DRESS occur after the drug exposure?

A

Onset 2-8 weeks after drug exposure

32
Q

What is the clinical presentation of DRESS?

A

Fever

Widespread rash

Eosinophilia

Deranged liver function

Lymphadenopathy

Maybe other organ involvement

33
Q

What is the treatment of DRESS?

A
  • Stop causative drug
  • Symptomatic and supportive
  • Systemic steroids
  • With or without immunosuppression or immunoglobins
34
Q

What is pemphigus?

A

Rare skin disorder characterized by blistering of your skin and mucous membranes

Antibodies targeted at desmosomes

35
Q

What is the clinical presentation of pemphigus?

A

Flaccid blisters that rupture very easily are seen in the skin

Intact blisters may not be seen

Nikolsky’s sign may be present

Commonly affects mucous membrane

Ill defined erosions in mouth

36
Q

Where does pemphigus commonly affect?

A

Face, axillar and groins

37
Q

What is pemphigoid?

A

Rare autoimmune disorder that can develop at any age, including in kids, but that most often affects the elderly. Pemphigoid is caused by a malfunction of the immune system and results in skin rashes and blistering on the legs, arms, and abdomen

38
Q

What is the clinical presentation of pemphigoid?

A

Intact epidermis forms roof of blister

Blisters are usually tense and intact

39
Q

In pemphigoid what are antibodies direct at?

A

Dermo-epidermal junction

40
Q

Compare and contrast pemphigus and pemphigoid?

A
41
Q

Which of pemphigus and pemphigoid is more common?

A

Pemphigoid

42
Q

Which of pemphigus and pemphigoid affects older patients?

A
43
Q

What is the treatment of pemphigus?

A

Systemic steroids

Dress erosions

Supportive therapies

44
Q

What is the treatment of pemphigoid?

A

Topical steroids may be sufficient if localised

Systemic usually required if diffuse

45
Q

What are some different kinds of psoriasis?

A

Erythrodermic psoriasis

Pustular psoriasis

46
Q

What are common causes of erythrodermic and pustular psoriasis?

A

Infection

Sudden withdrawal of oral steroids or potent topical steroid

47
Q

What is the clinical presentation of erythrodermic and pustular psoriasis?

A

Rapid development of generalised erythema with or without clusters of pustules

Fever

Elevated WCC

48
Q

What is the treatment of erythrodermic and pustular psoriasis?

A

Exclude underlying infection, bland emollient and avoid steroids

Often require initiation of systemic therapy

49
Q

What is eczema herpeticum?

A

Disseminated herpes virus infection on a background of poorly controlled eczema

50
Q

What is the clinical presentation of eczema herpeticum?

A

Monomorphic blisters and “punched out” erosions

Which are painful but not itchy

Fever and lethargy

51
Q

What is the treatment of eczema herpeticum?

A
  • Dose of aciclovir
  • Mild topical steroid if required to treat eczema
  • Treat secondary infection
  • Ophalmology input if peri-ocular disease

In adults consider underlying immunocompromised

52
Q

What is staphylococcal scaled skin syndrome?

A

Staphylococcus aureus produces an exfoliative toxin that causes the outer layers of skin to blister and peel, as if they’ve been doused with a hot liquid

53
Q

What does SSSS stand for?

A

Staphylococcal scaled skin syndrome

54
Q

Who is commonly affected by staph scaled skin syndrome?

A

Children

Can occur in immunocompromised adults

55
Q

What is the clinical presentation of staph scaled skin syndrome?

A
  • Diffuse erythematous rash with skin tenderness
  • More prominent in flexures
  • Blistering and desquamation follows
    • Staph procures toxin which targets desmoglein 1
  • Fever and irritability
56
Q

What is the treatment of staph scaled skin syndrome?

A
  • Admission for IV antibiotics initially and supportive care
  • Generally resolves over 5-7 days with treatment
57
Q

What is urticaria?

A

Raised, itchy rash that appears on the skin

58
Q

What is urticaria also known as?

A

Also known as hives, weals, welts or nettle rash

59
Q

What is the clinicla presentation of urticaria?

A
  • Central swelling of variable size, surrounded by erythema
  • Dermal oedema
  • Itching, sometimes burning
    • Histamine release into dermis
  • Fleeting nature, duration is 1 to 24 hours
  • Angioedema
    • Deeper swelling of the skin or mucous membranes
60
Q

When does acute urticaria become chronic?

A

After 6 weeks of history

61
Q

What are causes of acute urticaria?

A
  • Idiopathic 50%
  • Infection, usually viral 40%
  • Drugs, IgE mediated 9%
  • Food, IgE mediated 1%
62
Q

What is the treatment of acute uticaria?

A
  • Oral histamine
    • Taken continuously
    • Up to 4x dose
  • Short course of oral steroid may be of benefit if clear cause and this is removed
  • Avoid opiates and NSAIDs if possible (exacerbate urticarial)
63
Q

What is the cause of chronic uticaria?

A
  • Autoimmune/idiopathic 60%
  • Physical 35%
  • Vasculitic 5%
  • Rarely a type 1 hypersensitivity reaction
64
Q

What is the treatment of chronic uticaria?

A
  • Omalizumab
    • Monoclonal antibody to IgE

Derm yan (11 decks)

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