Emergencies and cutaneous drug eruptions

Question 1

What is erythroderma?

Answer 1

Rare

Intense widespread reddening of the skin associated with exfoliation (peeling)

Question 2

What conditions cause erythroderma?

Answer 2

Eczema, psoriasis, drug eruption

Pityriasis rubra pilaris

Question 3

What can erythroderma be a sign of?

Answer 3

Haematological malignancies
Internal malignancies (colon, lung, prostate)
HIV
Graft-vs-host disease

Question 4

How does erythroderma present?

Answer 4

Eyelid swelling --> ectropion
Intolerable itch
Warm skin
Onycholysis and dull, ridged, thickened nails
Lymphadenopathy

Question 5

What are the complications of erythroderma?

Answer 5

Hypothermia, dehydration, secondary skin infection, oedema

Question 6

How do you treat erythroderma?

Answer 6

Stop medications, optimise fluid balance and body temperature, maintain skin moisture, abx for infection

Question 7

What is Steven-Johnson Syndrome?

Answer 7

Aka toxic epidermal necrolysis
Rare, potentially fatal, almost always caused by drugs
HIV patients are high risk

Question 8

What causes SJS?

Answer 8

Systemic drugs with a long half-life
40% are antibiotics
Penicillins, cephalosporins, anti-convulsants, NSAIDs, paracetamol, nevirapine

Question 9

How does SJS present?

Answer 9

Fever >39C
Odynophagia, dysphagia
Rhinorrhoea, cough, myalgia
Sore, red eyes, conjunctivitis

Sudden onset of painful red rash starting on trunk and spreading over hours/days
Mucosal involvement

Question 10

How do you treat SJS?

Answer 10

Stop drugs, symptomatic treatment, fluid replacement
Topical antiseptics (skin)
Care for affected mucosal surfaces
Ventilation may be required if trachea and bronchi involved

Question 11

What are the most common drug eruptions?

Answer 11

Morbilliform

Urticaria and/or angioedema

Question 12

What are some SCARs?

Answer 12

Severe cutaenous adverse reactions
Drug hypersensitivity syndrome
SJS

Question 13

Who gets drug eruptions?

Answer 13

New medications
F>M
Genetics
Underlying viral infection
Hx of drug eruptions / allergies

Question 14

What causes drug eruptions?

Answer 14

True allergy ie immunological mechanism
Drug intolerance ie dose-related
Pseudoallergy ie release of mast cell mediators by the drug

Question 15

How do you treat drug eruptions?

Answer 15

Systemic steroids

Topical corticosteroids

Question 16

How do drug eruptions present?

Answer 16

Fever, malaise, other organ involvement (SCARs)