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Dermatology > Acute & Emergency Dermatology > Flashcards

Acute & Emergency Dermatology Flashcards

1
Q

What is erythroderma?

A

Inflammatory skin diseases affecting >90% of the total skin surface

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2
Q

What are the casuses of erythroderma?

A

Psoriasis
Eczema
Drugs
Cutaneous lymphoma

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3
Q

When do drug reactions usually take place?

A

1-2 weeks afterwards

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4
Q

What is morbilliform exanthem?

A

Measles like spots all over body as mild reaction

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5
Q

What are the severe drug reaction manifestations?

A

Erythroderma
Stevens Johnson Syndrome
Toxic epidermal necrolysis
DRESS

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6
Q

What is the prevalence of SJS/TEN?

A

SJS - 1-2/million

TEN - 0.4-1.2/million

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7
Q

SJS/TEN is secondary to what?

A

AntiB
Anticonvulsants
Allopurinol
NSAIDs

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8
Q

How does detachment of the epidermis present in SJS?

A

Patches all over body

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9
Q

How does detachment of the epidermis present in TEN?

A

Huge patch upper arms, chest

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10
Q

How does SJS present?

A

Fever, Malaise, Arthralgia
Rash
Mouth ulceration
Ulceration of other mucus membranes

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11
Q

How does the rash present in SJS?

A

Maculopapular
Target lesions
Blisters
Erosions <10% body

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12
Q

How does the mouth ulceration present in SJS?

A

Greyish/white membrane

Haemorrhagic crusting

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13
Q

How does toxic epidermal necrolysis present?

A

Prodromal febrile illness
Ulceration of mucus membranes
Rash

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14
Q

How does the rash present in toxic epidermal necrolysis?

A

Macular, purpuric or blistering
Sloughing desquamation >30% skin
Nikolsky sign may be positive

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15
Q

How is SJS/TEN managed?

A 
Identify and stop culprit drug
?Steroids
?IV Immunoglobulins
?anti-TNF therapy
?Ciclosporin
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16
Q

How is mortality scored in TEN/SJS?

A 
SCORTEN
Age > 40
Malignancy 
HR > 120
> 10% detachment
Urea > 10
Glucose > 14
Bicarbonate < 20
SJS 10%
TEN 30%
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17
Q

What long term complications is associated with TEN/SJS?

A 
Pigment skin changes
Scarring
Eye disease blindness
Nail and hair loss
Joint contractures
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18
Q

What is Erythema Multiforme?

A

Hypersensitivity triggered by infection

HSV, Mycoplasma pneumonia

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19
Q

How does Erythema multiforme present?

A 
Abrupt onset 100s of lesions in 24hrs
Distal -> proximal
Palms and soles
Mucosa 
Evolve macules - blisters
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20
Q

How is erythema multiforme managed?

A

Self limiting over 2 weeks

Treat symptomatically and cause

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21
Q

What is DRESS syndrome?

A

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

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22
Q

What is the prevalence of DRESS?

A

1:1/10,000

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23
Q

What is the mortality of DRESS?

A

10%

24
Q

How does DRESS present?

A

Onset 2-8 weeks post exposure
Fever and widepread rash
Eosinophilia, deranged LFTs
Lymphadenopathy

25
Q

How is DRESS managed?

A

Stop drug
Symptomatic and supportive
Systematic steroids
Immunosuppression or Ig

26
Q

What is Pemphigus?

A

Antibodies targeted at desmosomes
Flaccid blisters rupturing easily
Face, axillae, groin
Nikolsky’s sign may be +ve

27
Q

What is Nikolsky’s sign?

A

Epidermis sloughing off with friction

28
Q

Nikolsky’s sign is positive in what?

A

TEN/SJS

~Pemphigus

29
Q

How does pemphigus present?

A

Mucus membranes
Ill defined erosions in mouth
Opened/easily rupturing blisters

30
Q

What is pemphigoid?

A

Antibodies directed at dermo-epidermal junction
Intact epidermis forms roof of blisters
Blisters usually tense and intact

31
Q

How is pemphigus treated?

A

Systemic steroids
Dress erosions
Supportive
Methotrexate

32
Q

How is pemphigoid treated?

A

Topical steroids
Systemic if diffuse
Methotrexate

33
Q

How does pemphigoid differ from pemphigus?

A

Pemphigoid
Common
Elderly patients
Intact blisters

Pemphigus
Uncommon
Middle aged
Blisters fragile
Mucus membranes involved
34
Q

What are the common causes of erythrodermic/pustular psoriasis?

A

Infection

Sudden withdrawal of oral steroids/potent topical steroids

35
Q

How does erythrodermic/pustular psoriasis present?

A 
Rapidly developing:
Erythema
Clusters of pustules
Fever
↑ WCC
36
Q

How is erythrodermic/pustular psoriasis managed?

A

Exclude infection
Bland emollient
Avoid steroids
May require systemic therapy

37
Q

What is Eczema Herpeticum?

A

Disseminated herpes virus with a background of poorly controlled eczema

38
Q

How does Eczema Herpeticum present?

A 
Monomorphic blisters
"Punched out" erosions
Painful, not itchy
Fever
Lethargy
39
Q

How is Eczema Herpeticum treated?

A 
Aciclovir 
Mild topical steroid
Treat infection
Ophthalmology if eyes involved
Consider immunocompromised
40
Q

What is Staphylococcal Scalded Skin Syndrome?

A

Common in children
Immunocompromised adults
Staph infection

41
Q

How does Staphylococcal Scalded Skin Syndrome present?

A 
Diffuse erythematous rash 
Skin tenderness 
Blistering and Desquamation
More prominent in flexures
Fever
Irritability
42
Q

How is Staphylococcal Scalded Skin Syndrome managed?

A

IV AntiB

Supportive care

43
Q

How does staph cause Staphylococcal Scalded Skin Syndrome?

A

Staphylococcus produces toxin which targets Desmoglein 1

44
Q

How does a Hive present?

A

Central swelling of variable size
Surrounded by erythema
Itching/burning
Fleeting

45
Q

How does angioedema present?

A

Deep swlling of skin or mucous membranes

46
Q

What is the typical cause of acute urticaria?

A

Idiopathic
Infection (usually viral)
Drugs (IgE)
Food (IgeE)

47
Q

How is acute urticaria treated?

A

Oral antihistamine
Short course of oral steroid
Avoid opiates and NSAIDs

48
Q

What is the typical cause of chronic urticaria?

A

Autoimmune/idiopathic
Physical
Vasculitic
Type 1 hypersensitivity

49
Q

What is the first line of chronic urticaria management?

A

Non-sedating H1 antihistamine

50
Q

What is the 2nd line of chronic urticaria management after antihistamine?

A

Higher dose up to 4 times dose or second antihistamine

51
Q

What is the 3rd line of chronic urticaria management after

increased antihistamine?

A

Second line agent
Anti-leukotriene
Angioedema - transexamic acid

52
Q

What is the 4th line therapy for chronic urticaria?

A

Immunomodulant

Omalizumab

53
Q

Why are blisters usually intact in pemphigoid?

A

The blisters are deeper

54
Q

How is pustular psoriasis characterised?

A

Pustules are sterile

55
Q

How does Eczema herpeticum differ from Eczema?

A

Eczema herpeticum patients are systematically unwell

56
Q

What must be considered in an adult with Eczema herpeticum?

A

Do they have a history of eczema
Could they be immunocompromised
WCC
HIV

Dermatology (8 decks)

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