Acute and emergency dermatology

Question 1

List some consequences of the skin failing

Answer 1

sepsis
hypo/hyper thermia
protein and fluid loss
peripheral vasodilation –> heart failure in extreme cases

Question 2

Define erythoderma

Answer 2

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

Question 3

Causes of erythoderma (conditions)

Answer 3

psoriasis 
eczema 
drugs 
cutaneous lymphoma 
hereditary disorders

Question 4

Management of erythoderma

Answer 4

remove precipitating drug 
supportive therapy 
hydration 
appropriate setting 
manage itch 
emollient 
temperature regulation 
oral and eye care 
treat infection 
nutrition

Question 5

What is the cause of SJS/TEN? give examples

Answer 5

secondary to drugs eg antibiotics, anti-histamines, allopurinol, NSAIDs

Question 6

Is SJS or TEN more severe? Why?

Answer 6

TEN

Amount of surface epidermal detachment

Question 7

Symptoms of SJS

Answer 7

fever, malaise and arthralgia

Question 8

SJS rash

Answer 8

maculopapular

blisters

Question 9

How much of skin surface is covered in erosions in SJS?

Answer 9

<10%

Question 10

Mouth appearance in SJS

Answer 10

greyish white membrane

haemorrhagic crusting

Question 11

How does TEN often present?

Answer 11

prodromal febrile illness

Question 12

Are mucous membranes ulcerated in SJS or TEN?

Answer 12

both

Question 13

TEN rash

Answer 13

macular, purpuric or blistering

rapidly becomes confluent and desquamation

Question 14

What is nikolsky’s sign? What are 2 conditions it may be positive in?

Answer 14

blister formation by pressing on skin

TEN and pemphigus

Question 15

Management of SJS/TEN?

Answer 15

stop precipitating drug
supportive therapy eg temp, infections
?? high dose steroids, immunoglobulins, anti TNF therapy, ciclosporin

Question 16

SCORTEN - SJS/TEN prognosis

Answer 16

age >40 
malignancy 
HR >120 
initial epidermal detachment >10%
serum urea >10
serum glucose >14 
serum bicarbonate >20

Question 17

Long term complications of SJS/TEN

Answer 17

scarring 
pigmentary skin changes 
eye disease and blindness 
nail and hair loss 
joint contractures

Question 18

What is erythema multiforme triggered by?

Answer 18

hypersensitivity reaction triggered by infection - HSV then mycoplasma pneumonia

Question 19

Onset of EM?

Answer 19

very rapid

Question 20

Appearance of EM

Answer 20

from distal –> proximal

palms and soles, mucosal surfaces, pink macules become elevated and blister

Question 21

Treatment of EM

Answer 21

self limiting

treat underlying cause

Question 22

When does DRESS occur?

Answer 22

2-8 weeks after drug exposure

Question 23

DRESS signs/symptoms

Answer 23

fever, widespread rash, eosinophilia, deranged liver function, lymphadenopathy

Question 24

DRESS treatment

Answer 24

stop causative drug
symptomatic and supportive
systemic steroids
+/- immunosuppression or immunoglobulins

Question 25

Pemphigus cause

Answer 25

antibodies targeted at desmosomes

Question 26

Pemphigus appearance

Answer 26

watery blisters, intact blisters may not be seen, rupture easily, flaccid blisters

Question 27

Where is pemphigus found?

Answer 27

mucous membranes, face, axilla, groin, eyes, nose

Question 28

2 biopsies for pemphigus techniques

Answer 28

immunofluorescence | histopathology

Question 29

Pemphigoid cause

Answer 29

antibodies directed at dermo-epidermal junction

Question 30

Blisters in pemphigoid

Answer 30

intact epidermis forms roof of blister | usually tense and intact

Question 31

Causes of erythodermic/pustular psoriasis

Answer 31

infection | sudden withdrawl of oral or potent topical steroids

Question 32

Appearance of erythodermic/pustular psoriasis and symptoms

Answer 32

generalised erythema - groups of pustules | fever, infection, Increased WCC

Question 33

Treatment of erythodermic/pustular psoriasis

Answer 33

bland emollient and systemic therapy

Question 34

What should be avoided in erythodermic/pustular psoriasis treatment?

Answer 34

steroids

Question 35

What is eczema herpeticum?

Answer 35

Disseminated herpes virus infection on a background of poorly controlled eczema

Question 36

eczema herpeticum symptoms and signs

Answer 36

fever, lethargy, monomorphic blisters, punched out erosions, painful

Question 37

eczema herpeticum treatment

Answer 37

acyclovir, mild topical steroid, ophthalmology

Question 38

What is something to think about with eczema herpeticum in adults?

Answer 38

immunocompromised

Question 39

People affected by staphylococcal scaled skin syndrome

Answer 39

children and immunocompromised adults

Question 40

How does staphylococcal scaled skin syndrome start?

Answer 40

staph infection, diffuse erythematous rash, skin tenderness

Question 41

How does staphylococcal scaled skin syndrome proceed?

Answer 41

desquamation, blistering, fever and irritability

Question 42

staphylococcal scaled skin syndrome treatment

Answer 42

IV antibiotics, supportive care

Question 43

Other names for urticarial

Answer 43

wheal or hives

Question 44

Describe an urticaria lesion

Answer 44

central swelling of varying size surrounded by erythema dermal oedema itching and burning due to histamine release

Question 45

Consequence of angioedema in urticaria

Answer 45

deeper swelling of skin or mucous membranes

Question 46

4 causes of acute urticaria

Answer 46

food drugs idiopathic infection - viral

Question 47

Treatment of acute urticaria

Answer 47

oral antihistamine | oral steroids

Question 48

2 things to avoid in urticaria

Answer 48

NSAIDs and opiates

Question 49

3 causes of chronic urticaria

Answer 49

autoimmune/idiopathic physical vasculitic

Question 50

Management of urticaria

Answer 50

antihistamine anti leukotriene immunomodulant