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Flashcards in Emergency Dermatology Deck (68)
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1

What can skin failure lead too / all conditions

2 bacterial infection
Sepsis
Dehydration
Electrolyte imbalance
Hypo / hyperthermia
Renal impairment
Peripheral vasodilatation
Cardiac failure

2

What is pirnciple of management of dermatological emergencies

Full supportive care - ABC of resus
Withdrawal of any precipitating agent
Fluid balance
Temp regulation
Emollients
Anticipate and treat infection
Management of any complications
Specific Rx

3

What is erytheroderma and what can cause

An exfoliative erythematous dermatitis affecting >90% of body
Psoriasis
Eczema
Drugs - penicillins, cephalosporin, AED, allopurinol
Cutaneous lymphoma
Hereditary disorders
Abrupt steroid withdrawal in erythrodermis psoriasis

4

How does it present and what are complications

Inflammed oedematous scaly skin
Itchy
Systemically unwell - LN / malaise
Secondary infection
Fluid loss and electrolyte imbalance
Hypothermia
High output cardiac failure
Capillary leak syndrome = most severe

5

What happens in erythodermis psoriasis

Progress to exfoliative phase
Plaques over whole body
Mild systemic upset

6

How do you manage erythroderma

ITU / burns unit
Remove offending drug / treat cause
Fluid balance
Nutrition
Temp regulation
Emollient and wet wraps to maintain skin moisture
Topical steroid may help relieve inflammation
Oral and eye care
Manage itch

7

What is urticaria

Weals / Hive's
Acute <6 weeks
Chronic

8

What is pathophysiology behind / type of hypersensitivity

Type 1 - IgE if acute
Chronic less likely
Due to local increase in permeability of capillaries
Histamine from mast cell = major inflammatory mediator

9

How does it present

Central swelling - variable size that involves superficial dermis raising the epidermis
Surrounded by patchy erythematous rash
Associated dermal oedema / flushing of skin
Itching / burning as histamine released - ask if rash itchy
Usually lasts 1-24 Horus

10

What is associated with urticaria and where do they affect

Angiooedema
- Deeper swelling involving dermis and SC tissue
- Skin or muscle membranes so throat, tongue and lips

Anaphylaxis
- Bronchospasm
- Facial and laryngeal oedema
- Hypotension
- Can initially present with urticaria and angioedema

11

What causes acute urticaria

Idiopathic in 50%
Allergy stimulating release of mast cell contents = most common
Food
Insect bites
Chemicals - latex
Viral or parasitic infection
Drugs - ask if any new drug etc (NSAID, ACEI, opiates, thiazide, phenytoin)
Autoimmune
Vacinations
Hereditary angioedema in some cases

12

How do you treat acute urticaria and associations if occur

Consider trigger and withdraw - opiate / NSAID
Oral anti-histamine 3x daily = mainstay
Corticosteroid if severe urticaria or angioedema + PPI
Treat as anaphylaxis if obstruction

13

What are complications

Urticaria = no complications
Asphyxia, cardiac arrest and death if angiodema / anaphylaxis

14

What causes chronic urticaria

Autoimmune disease where Ab target mast cells
Physical trauma
Vasculitis

15

How do you Rx

Anti-histamine
May need higher dose or 2nd
Consider Immunomodulant / biologic
Limited use of steroids

16

What should you consider if angiodema present

Anti-leukotriene
Tranexamic acid

17

Types of anti-histamine

Chlorophenamine = sedating
May have anti-muscarinic properties
Certrizine = non-sedating

18

When do drug reactions commonly begin

1-2 weeks after drug

19

What is mild drug reaction

Morbilliform exanthema
Macular red lesions
2-10mm but join up
Erythema multiform

20

What are severe drug reactions

Erythroderma
SJS - <10%
TEN >30%
DRESS

21

What are common drugs that cause / infection

Drugs = main cause
Antibiotics - penicillin
Anti-convulsants - phenytoin / carbamazepine
Sulphonamides
Allopurinol
NSAID

Infection
HSV
Mycoplasma
CMV
HIV

22

What is SJS

Severe variant of erythema multiforme (<1 mucosal)
Mucocutaneous necrosis with 2+ mucosal sites involved
Skin involvement may be limited or extensive

23

How does it present

May have prodromal febrile illness
Maculopapular rash <10% of skin surface
Target lesions
Blisters
Mouth / genital / eye ulceration
Cause greyish white membrane
Fever
Malaise
Arhtralgia
Histopathology = epidermal necrosis

24

How does TEN usually present

Prodromal febrile illness
Extensive skin and mucous membrane invovlement
Ulceration mucous membrane
May start macular or purpuric
Then blister
Become confluent >30% BSA
Leads to large loss of epidermis - desquamation
Systemically UNWELL
Nikolsky +ve - blisters form when rub back and forth
Histopathology = full thickness necrosis with detachment

25

Prognosis of TENS and SJS

Very serious
High mortality from sepsis / electrolyte imabalcen and multi-organ failure

26

How do you manage TEN / SJS

Early recognition and help
ITU
Stop culprit drug
Full supportive care
Nutrition
Anti-septic
Analgesia
Opthamology input
IV IG = 1st line
Role of biologics / immunosuppression / steroid

27

What score to measure mortality

SCORTEN

28

What does it look at

Age
Malignancy
HR
Initial epidermal detachment >10%
Urea >10
Glucose >14
Bicarb <20

29

What are complications

Secondary bacterial infection
Sepsis
Multi-organ failure
Electrolyte imbalance
Pigmentary skin change
Scarring
Eye disease - blindness
Nail and hair loss
Joint contractures

30

What is DRESS

Drug reaction with eosinophilia and systemic symptoms