Dermatology

Question 1

what score is used to predict mortality in SJS and TEN?

Answer 1

SCORTEN
- > 40 years old
- presence of malignancy
- heart rate >120
- initial % of epidermal
- detachment >10%
- serum urea level >10mmol/L
- serum glucose level >14 mmol/l
- serum bicarb level <20mmol/L

Question 2

what is TEN?

Answer 2

• potentially life threatening skin disorder that’s characterised by extensive skin and mucosal necrosis with systemic toxicity. Involving over 30% of the body surface area
• widespread painful erythema with necrosis of large sheets of the epidermis

Question 3

what is SJS?

Answer 3

mucocutaneous necrosis involving atleast 2 mucosal sites, affecting <10% of the body surface area

Question 4

dermatological features of SJS?

Answer 4

• abrupt onset of painful skin rash
• maculopapular with target lesions
• diffuse erythema
• blisters
• nikolsky positive

Question 5

what is SSSS + pathophysiology?

Answer 5

severe superficial blistering skin condition, characterised by the detachment of the epidermis (outerlayer of skin)
- staphylococcus aureus produces epidermolytic toxins, this toxin is a protease enzyme that breaks down the proteins that hold the skin together

Question 6

how does SSSS present?

Answer 6

• usually starts with fever
• then generalised patches of erythema
• then after 24-48 hours, scalded skin like appearance followed by large flaccid bullae
• perioral crusting

Question 7

management of SSSS?

Answer 7

• antibiotics: pencillinase resistance penicillin, erythromycin, appropriate cephalosporin
• fluid and electrolyte balance
• paracetamol for fever and pain
• skin care eg. petroleum jelly

Question 8

what is necrotising fasciitis and the types?

Answer 8

• rapidly spreading severe infection of the deep fascia, associated with soft tissue necrosis
• Type 1: mixture of anaerobic and aerobic bacteria (common post surgery in diabetics)
• Type 2: group A haemolytic streptococcus eg. strep pyogenes

Question 9

how is eczema herpeticum managed?

Answer 9

• oral (or IV) acyclovir 5/day for 10-14 days
• oral flucloxacillin if secondary bacterial infection
• stop topical steroids, prevents HSV infection from spreading further
• if eye involvement, oral ganciclovir 5/day for 7-10 days

Question 10

how does eczema herpeticum present?

Answer 10

• monomorphic punched out erosions
• crusted papules
• vesicles
• ## systemic symptoms and lymphadenopathy