derm emergencies Flashcards
A 28-year old female presents to her GP with an itchy rash covering her arms, chest and neck. She’s getting married in one week and has been busy planning it all. No PMH. Non-smoker. Social drinker. Clinical examination confirms the presence of urticarial weals with surrounding erythema.
What is the first line treatment?
give cetrizine
A father brings in his 4-year old son to A&E from a birthday party with significant facial swelling around the eyes and mouth. Eli had been well prior to this event. O/E: No airway compromise.
Which dermatological manifestation almost always occurs with this type of angioedema?
weals
uticaraia is mast cell activation due to alleriges or infection and can occur anywhere solving in 48 hours
mx?
identify trigger
anti-pruritics like calamin losion
antihsimines such as cetrizine and loratiine
angioodema is lcoal non inlfmamtory self limitin goedema allergic aagin and commonly hwat drugs
ACEi
angioodeema commonly found on skin and mucosa and genitals what give to treat if airways involvement too
adrenaline for airways
then antihsitamiens H1
A middle-aged man man develops a non-pruritic rash on his hands, torso and back. He was recently diagnosed with atypical Trigeminal neuralgia and started on carbamazepine 1 day ago.
Given the most likely diagnosis, what is the most common trigger of this condition?
PMH of psoriasis
erythema miltiform is hypersensitivy reaction to certain drugs can follo upper resp infection how long to resolve
3-5 weeks
A young boy presents with a sudden onset painful rash covering his face, torso and arms. He just finished a 5-day course of penicillin for an infection. The EM F1 documents SJS/TEN as the top differentials. Which of the following suggests SJS instead of TEN?
lesions covering under 10% of body
under 10 percetn
SJS
drugs that cause SJS and TEN
Antibiotics: trimethoprim/sulfamethoxazole and other sulphonamide antibiotics, as well as aminopenicillins, quinolones and cephalosporins.
Anticonvulsants: carbamazepine, phenobarbital, phenytoin, lamotrigine and valproic acid
Recent infections: Mycoplasma pneumonia; Viral infections include herpes, Epstein-Barr virus, and cytomegalovirus
Other medications: antifungals, antivirals, antiretrovirals, analgesics (e.g. paracetamol), NSAIDs, COX-2 inhibitors, corticosteroids, azathioprine, sulfasalazine, allopurinol
Systemic lupus erythematosus; HIV/AIDS
Radiotherapy: oncology patients are immunocompromised from the disease process and chemotherapy. SJS/TEN is seen most frequently with recent anticonvulsant medicine during cranial irradiation.
sx of SJS and TEN
Prodromal phase 2-3 days, URTI with fever
Spread from the face or upper trunk - Ill-defined red ‘burning/painful’ macular/papular lesions
Bullae form and coalesce, then sloughing of skin
At least 2 areas of mucosal involvement:
*Eyes – conjunctivitis , corneal ulceration, photosensitivity *Lips / mouth – crusted lips and mouth ulcers
*Pharynx, oesophagus – difficulty swallowing
*Genital area and urinary tract – erosions, ulcer, UTI *Upper respiratory tract – cough, resp. distress
*GI tract – diarrhoea
Systemic features: hyperpyrexia, hypotension, tachycardia secondary to dehydration and hypovolaemia
Nikolsky’s sign +ve - ayers of skin slip away on rub
