Acute Dermatology Flashcards
(14 cards)
What is erythroderma?
Redness of the skin covering more than 90% of the skin
What are six causes of erythroderma?
Psoriasis Eczema Idiopathic Hereditary disorders Drugs Cutaneous lymphoma
What drugs can cause SJS/TEN?
Anticonvulsants
Antibiotics
Allopurinol
NSAIDS
What is the difference between SJS and TEN?
The extension of the disease. It progresses to being called TEN if over 30% of the body is affected.
What are the clinical features of SJS/TEN?
Often presents with a flu like prodrome. Fever, malaise, arthralgia Rash Maculopapular, target lesions, blisters Erosions covering <10% of skin surface as skin sloughs off Mouth ulceration Greyish white membrane Haemorrhagic crusting Ulceration of other mucous membranes Positive Nikolsky sign-skin comes off when rubbed gently
How are SJS/TEN managed?
Remove offending drug if possible
Supportive therapy
Possible therapies could be ciclosporin, high dose steroids, immunoglobulins or anti-TNF therapy
What aspects are considered in SCORTEN?
Age >40 Malignancy Heart rate >120 Initial epidermal detachment >10% Serum urea >10 Serum glucose >14 Serum bicarbonate <20
What is erythema multiforme?
A hypersensitivity reaction usually triggered by infection from HSV or Mycoplasma pneumonia. Abrupt explosion of lesions over 72 hours on the distal surfaces, palms and soles and mucosal surfaces. Usually self limiting and resolves in around two weeks.
What is DRESS and how is it managed?
A rash and fever from a drug reaction around 2-8 weeks after exposure. Rash is non specific so diagnosis comes from raised eosinophil count, altered LFT and EGFR and lymphadenopathy. Treated with systemic steroids and if needed immunoglobulins.
What is Pemphigus and what are the clinical features?
Antibodies targeting the desmosome. Skin – flaccid blisters, rupture very easily Intact blisters may not be seen Common sites – face, axillae, groins Nikolsky’s sign may be +ve Commonly affects mucous membranes Ill defined erosions in mouth Can also affect eyes, nose and genital areas
What are the differences between pemphigus and pemphigoid?
Pemphigus
Uncommon
Middle aged patients
Blisters very fragile – may not be seen intact
Mucous membranes usually affected
Patients may be very unwell if extensive
Treat with systemic steroids. Dress erosions. Supportive therapies
Pemphigoid
Common
Elderly patients
Blisters often intact and tense
Even if extensive, patients are fairly well systemically
Topical steroids may be sufficient if localised; systemic usually required if diffuse
What is eczema herpeticum and how is it managed?
Disseminated herpes virus infection on a background of poorly controlled eczema
Monomorphic blisters and “punched out” erosions
Generally painful, not itchy
Fever and lethargy
Treatment dose Aciclovir
Mild topical steroid if required to treat eczema
Treat secondary infection
Ophthalmology input if peri-ocular disease
What is Staphylococcal scalded skin syndrome and how is it managed?
Common in children, can occur in immunocommpromised adults
Initial Staph. infection
May be subclinical
Diffuse erythematous rash with skin tenderness
More prominent in flexures
Blistering and desquamation follows
Staphylococcus produces toxin which targets Desmoglein 1
Fever and irritability
Require admission for IV antibiotics initially and supportive care
Generally resolves over 5-7 days with treatment
What are the triggers for acute urticaria and how is it managed?
Infection, drugs, food or idiopathic
Oral antihistamine
Taken continuously
Up to 4 x dose
Short course of oral steroid may be of benefit if clear cause and this is removed
Avoid opiates and NSAIDs if possible (exacerbate urticaria)
