Acute And Emergency Dermatology Flashcards
(31 cards)
What are the causes of erythrodema?
Psoriasis Eczema Drugs Cutaneous lymphoma Hereditary disorders Unknown
Describe the management of erythrodema
Remove any offending drugs
Ensure careful fluid balance, temperature regulation and good nutrition
Emollients can be useful- 50:50 to regain skins function as a barrier
Oral and eye care
Anticipate and treat infection
Manage itch
Treat cause
What is the difference between Stevens Johnson syndrome and toxic epidermal necrolysis?
SJS tends to cover less of the skin than TEN
SJS tends to affect children and immunosuppressed adults, TEN affects adults
What are the clinical features of Stevens Johnson syndrome?
Fever, malaise and arthralgia
Rash (maculopapular, target lesions, blisters. Erosions covering <10% of skin surface)
Mouth ulceration and ulceration of other mucous membranes
What are the clinical features of toxic epidermal necrolysis?
Often presents with prodromal febrile illness
Ulceration of mucous membranes
Rash- May start as macular, purpuric or blistering. Rapidly becomes confluent and sloughing off of large areas of epidermis common
Describe the management of SJS/TEN?
Identify and stop culprit drug ASAP, stop anything not 100% necessary
Give dressings, topical antibacterial agents and emollients
IV fluids/nutritional support may be necessary
What criteria make up a SCORTEN score for SJS/TEN?
Age >40 Malignancy Heart rate >120 Initial epidermal detachment >10% Serum urea >10 Serum glucose >14 Serum bicarbonate <20
What are the long term complications of SJS/TEN?
Pigemntary skin changes Scarring Eye disease and blindness Nail and hair loss Joint contractures
What is the cause of erythema multiforme?
Hypersensitivity reaction usually triggered by infection, most commonly HSV
How does erythema mutliforme present?
Abrupt onset of up to 100s of lesions over 24 hours, starting distally and becoming more proximal
Lesions then evolve over 72 hours with pink macules becoming elevated and sometimes blistering
Self limiting and resolves over 2 weeks
Describe the management of erythema mulitforme
Treat underlying cause
What are the characteristics of drug reaction with eosinophilia and systemic symptoms (DRESS)
Onset 2-8 weeks after drug exposure
Fever and widespread rash
Eosinophilia and deranged liver function
Lymphadenopathy
Describe the management of drug reaction with eosinophilia and systemic symptoms
Stop causative drug
Treat symptoms
Give systematic steroids
Immunosuppressive/immunoglobulins may or may not be necessary
What are the clinical features of pemphigus?
Antibodies targeted at desmosomes
Flaccid blisters that ruptured easily
Blisters common on face, axillae and groin
Commonly affects mucous membranes
Ill defined erosions in mouth
Can also affect eyes, nose and genital areas
Describe the characteristics of pemphigoid?
Antibodies directed at dermo-epidermal junction
Intact epidermis forms roof of blisters, which are usually tense and intact
What’re the main differences between pemphigus and pemphigoid?
Pemphigus- uncommon, middle aged patients, blisters very fragile
Pemphigoid- common, elderly, blisters often intact and tense
Describe the management of pemphigus
Give systemic steroids
Dress erosions
Supportive therapies may be needed
Describe the management of pemphigoid
Topical steroids sufficient if localised, systemic steroids required if diffuse
What are the most common causes of erythrodermic/pustular psoriasis?
Infection
Sudden withdrawal of oral steroids or potent topical steroids
What are the characteristics of erythrodemic/pustular psoriasis?
Rapid development of generalised erythema +/- pustules
Fever
Elevated WCC
Describe the management of erythrodermic/pustular psoriasis
Exclude underlying infection
Give bland emollient
Often requires systemic therapy
What are the characteristics of eczema herpeticum?
Disseminated heroes virus infection with a background of poorly controlled eczema
Monomorphic blisters and erosions
Fever and lethargy
Describe the management of eczema herpeticum
Give aciclovir
Mild topical steroid if required to treat eczema
Treat secondary infection
Ophthalmology input it if peri-ocular disease
Describe the characteristics of staphylococcal scalded skin syndrome
Common in children and immunocompromised adults
Initial staph infection
Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation follows
Fever and irritability
