Dermatology - emergencies Flashcards

(26 cards)

1
Q

What are the main dermatological emergencies?

A

Erythroderma from any cause
Severe adverse drug reaction
Infection-related issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is erythroderma?

A

Intense reddening of the skin, often followed by massive exfoliation (exfoliation dermatitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of erythroderma

A
  • Infection
    • Drug reaction
    • Psoriasis
    • Less common
      ○ HIV
      ○ Paraneoplastic syndrome
      ○ Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complications of erythroderma

A
  • Temperature irregulation
    • Fluid and electrolyte disturbances
    • Infection risk
    • Haemodynamic instability
    • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for erythroderma

A

Emollients, corticosteroids, wet wraps

Treat underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the severe dermatological drug reactions?

A
  • TEN
    • Steven-Johnson syndrome
    • Red man syndrome (idiopathic erythroderma)
    • DRESS
    • AGEP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does DRESS stand for? (derm)

A
  • drug reaction with eosinophilia and systemic symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which two dermatological drug reactions are throught to be the same process but on different ends of the spectrum?

A

TEN and SJS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What doe TEN stand for (derm condition)

A

Toxic epidermal necrolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which condition is more serious, TEN or SJS?

A

TEN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of Steven Johnson’s syndrome?

A

○ a targetoid atypical rash (<10% of body surface area)
○ Eye and genital ulcerations possible and are serious issues
○ Haemorrhagic stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of SJS?

A

Stop drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathology of TEN?

A

Widespread keratinocyte necrosis provoked by cell mediated cytotoxic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes TEN?

A

Over 220 drugs implicated

Common ones: Sulfonamids, anticonvulsants, NSAIDs, Dapsone, allopurinol, other antibiotics

vaccines (MMR)

Polio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Extra-cutaenous manifestations of TEN?

A

○ Fever
○ Purulent conjunctivitis
○Mucositis (GI, resp, genitals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prognostic indicators for TEN/ SJS

A

SCORETEN score

Thrombocytopaenia/ neutropania

delayed admission, treatment with corticosteroids

17
Q

Complications of TEN/ SJS?

A
○ Sepsis
	○ Multiorgan failure (>30%)
	○ Metabolic abnormalities
	○ Pulmonary isses (>15%) - E.g. embolus
	○ GI haemorrhage
18
Q

What is the management for toxic epidermal necrolysis?

A
  • Withdraw the drug
    • Admit to burns unit - supportive measures
      ○ Fluids and electrolytes
      ○ thermoregulation
      ○ Monitor for complications - infections
    • No steroids!
    • IVIG or plasmapharesis (controversial)
19
Q

What is the rash like in DRESS syndrome?

20
Q

What are the systemic symptoms in DRESS syndrome?

A

Fever, hepatitis, lympadenopathy pneumonitis, nephritis

21
Q

What is the management of DRESS syndrome?

A

withdraw the drug

may need systemic prednisolone

22
Q

What does AGEP stand for? (derm condition)

A

acute generalised exanthematous pustulosis

23
Q

Which medications does AGEP tend to occur in?

A

Antibiotics in particular

24
Q

Clinical picture in AGEP?

A

24-48h after the medication
pustules everywhere
can be febrile, unwell
usually resolves with desquamation once drug ceased

25
What are the two main dermatological emergencies are related to infection?
Scalded skin syndrome | Toxic shock syndrome
26
What bacteria cause scalded skin syndrome and toxic shock syndrome
SSS - staph aureus | TSS - staph aureus or strep pyogenes