Dermatological emergencies

Question 1

What are some examples of dermatological emergencies?

Answer 1

• Erythema multiforme
• SCC
• Bullous pemphigoid
• Erythroderma
• Henoch shonlein purpura
• Measles
• Toxic epidermal necrolysis

Question 2

What are the 2 classes of erythema multiforme?

Answer 2

Minor = Skin only

Major = Skin + Mucous membranes

Question 3

What are some causes of erythroderma?

Answer 3

• Idiopathic
• Drugs (E.g. sulphonamides, penicillin, anti-malarials, anti-convulsants, allopurinol)
• Eczema
• Psoriasis
• Cutaneous T-cell lymphoma (Sezary syndrome)
• Pityriasis rubra pilaris
• Blistering (Pemphigus and bullous pemphigoid)

Question 4

What investigations are required in erythroderma?

Answer 4

• Skin swabs
• Septic screen
• FBC and U&E
• HIV test
• Echocardiogram
• Skin biopsy

Question 5

How is erythroderma managed?

Answer 5

• Admit
• Stop offending drug if necessary
• Emollients
• Mild to moderate potency topical steroids
• Manage fluid balance and temperature
• IV antibiotics if required
• Anti-histamines
• Skincare
• Treat according to cause (MTX for psoriasis)

Question 6

What is erythroderma?

Answer 6

A severe inflammation of most of the bodies surface

Question 7

What is toxic epidermal necrolysis?

Answer 7

A rare, acute, lifethreatening skin/mucous membrane reaction to usually a medication, characterised by epidermal death (Necrosis)

Question 8

What is the precursor condition of toxic epidermal necrolysis?

Answer 8

Steven Johnson syndrome

Question 9

What are the 3 stages of body surface desquamation?

Answer 9

• <10% = Steven Johnson Syndrome
• 10-30% = SJS/TEN overlap
• > 30% = Toxic epidermal necrolysis

Question 10

What are some causes of toxic epidermal necrolysis?

Answer 10

Drugs (80%)
Infection

Question 11

What are some drugs that can cause toxic epidermal necrolysis?

Answer 11

Allopurinol, Sulfasalazine, carbemazepine, lamotrigine, phenytoin, cephalosporins, NSAIDs, macrolides, omeprazole

Question 12

What are some infections that can cause toxic epidermal necrolysis?

Answer 12

• Mycoplasma pneumoniae
• Herpes simplex

Question 13

What are the stages of evolution of a rash in toxic epidermal necrolysis?

Answer 13

Prodrome
Prodromal rash
Necrotic epidermolysis
Full thickness epidermal detachment

Question 14

What are the prodromal features of TEN?

Answer 14

Fever
Malaise
Arthralgia

Question 15

Describe the features of the prodromal rash of TEN

Answer 15

Morbilliform, diffuse erythema, can be target like, rapid confluence of lesions

Question 16

Describe the features of necrotic epidermolysis in TEN

Answer 16

Macular areas with a crinkled surface that enlarge and coalesc, then sheet like loss of epidermis, raised flaccid blisters, positive nikolsky sign

Question 17

Describe the features of full thickness epidermal detachment in TEN

Answer 17

Red, fleshy dermis exposed, resembling a burn

Question 18

What are some mucous membranes that can be involved in TEN?

Answer 18

Mouth, eyes, nasal, resp, GI, urethra, vagina

Question 19

What are some investigations required in TEN?

Answer 19

• FBC (Neutropenia has poor prognosis)
• U+E (High urea and low bicarb has poor prognosis)
• Skin biopsy (Necrosis throughout epidermis and subepidermal split above basement membrane

Question 20

How is TEN managed?

Answer 20

• Withdraw suspected drug
• Biopsy
• Meticulous skin care by ITU nurses
• IV fluids
• Analgesia

Question 21

What are some supportive measures used in TEN?

Answer 21

• Avoid skin trauma with loss pressure mattresses
• Treat complicating infections