Emergency Dermatology Flashcards

Question

Prognosis of TENS and SJS

Answer 1

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

Answer 2

``` 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 ```

Answer 3

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

Answer 4

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

Answer 5

Drug reaction with eosinophilia and systemic symptoms

Answer 6

``` 2-8 weeks after drug Fever Widespread rash Eosinophilia Deranged liver function Lymphadenopathy ```

Answer 7

Stop drug Systemic steroid Immunosuppression / Ig

Answer 8

Autoimmune disease where Ab at desmosomes within epidermis cause dermis and epidermis to stick together and causing epidermal intra-epidermal split Desmoglein 3 Tends to affect middle age

Answer 9

``` Flaccid blisters Rupture easily Form erosion and crust Typically painful Common at face, axillae and groin Mucosal ulceration common which can proceed skin NOT itchy Nikolsky's sign Patient very unwell If mucosal involvement = vulgaris Worse involvement ```

Answer 10

Biopsy shows acanthylsis

Answer 11

``` Wound dressing Monitor for infection Good oral care High dose oral steroid Immunosuppression - Methotrexate - Azathioprine - Cyclophosphamide - MMF ```

Answer 12

More common condition presenting in the elderly | Autoimmune where Ab directed at derma-epidermal junction causing sub-peridermal split and blister

Answer 13

Underlying malignancy

Answer 14

``` Intact epidermis forms roof of blister Itchy before blister Blister = tense and intact Erythematous base Do not break Can be haemorrhagic Trunk and upper limb Heal without scarring Patient well NO mucosal involvement ```

Answer 15

Bloods Biopsy CXR for malignancy

Answer 16

Wound dressing where required Topical steroid if local Oral steroid Combination steroid / Ax / immunosuppression Immunosuppression - not great if underlying cancer

Answer 17

Acute self-limiting hypersensitivity reaction triggered by - HSV = most common - Mycoplasma pneumonia - Drugs - SLE / sarcoid - Malignancy

Answer 18

Penicillin OCP NSAID

Answer 19

``` Abrupt onset of 100s of lesions over 24-72 hours Initially back of hands and feet Then torso Mucosal surfaces absent or LIMITED TO ONE surface Widespread itchy erythematous rash Target lesion Symmetrical with central blister Pink macule becomes elevated May blister Occasional pruritus Severe form = SJS / TEN May have associated fever, arthralgia, stomatitis ```

Answer 20

``` Self limiting A form of SJS so early recognition important Resolve over 2-6 weeks Treat underlying cause If underlying cause not known - CXR to look for pneumonia If severe may need admission for IV fluid, analgesia and steroid Steroid for itch remains controversial ```

Answer 21

Disseminatd HSV infection on background of atopic eczema or less commonly other skin conditions

Answer 22

``` Widespread eruption Extensive crusted papule Monomorphic blisters + vesicles Punched out erosion Painful NOT itchy but can be Systemically unwell - fever, lethargy ``` Secondary infection Herpes hepatitis Encephalitis DIC

Answer 23

Acyclovir - oral or IV Mild steroid for eczema Ophthalmology review if near eyes Ax if bacterial secondary infection

Answer 24

Underlying immunosuppression e.g. HIV

Answer 25

Infection Sudden withdrawal of steroids Can occur without psoriasis

Answer 26

Rapid development of generalised erythema + pustules Fever Elevated WCC

Answer 27

Avoid steroid in psoriasis patient Systemic therapy Treat infection

Answer 28

S.Aureus produces toxin which targets desmoglein 1 and causes skin to break down Children Immunocompromised adults

Answer 29

``` Hx of staph infection initial Develops within hours - days Worse over face, neck, groin Diffuse erythematous rash VERY PAINFUL Scald like skin appearance followed by large flaccid bullae Blisters / bullae form Intra-epidermal blistering Nikolsky +ve - rubbing skin causes it to peal Desqaumation Systemically unwell - Fever / Irritability Recovery within 5-7 days ```

Answer 30

``` Admit IV Ax Analgesia Fluid balance as prone to dehydration Usually make a full recovery without scarring ```

Answer 31

Rapidly spreading infection of deep fascia with secondary tissue necrosis Infection may not be noticeable on skin initially as affecting deep structures

Answer 32

Group A strep

Answer 33

Abdo surgery DM Malignancy

Answer 34

SEVERE pain Erythematous, blistering and necrotic skin Swelling Systemically unwell with fever and tachycardia+ hypo After 3-4 days necrotic change occurs - rash swells and becomes dark purple with blisters Presence of crepitus

Answer 35

Subcutaneous emphysema as gas in the tissue

Answer 36

Presence of gas (absence does not exclude)

Answer 37

``` ABCDE Bloods VBG - lactate + metabolic acidosis Urgent referral for surgical debridement IV Ax Transfer to ITU ```

Answer 38

Pain out of proportion even if no skin involvement yet

Answer 39

``` Type 1 = poymicrobial - DM and elderly Type 2 = flesh eating (strep pyogenes) - Most common and can occur in healthy Type 3 = clostridium - Post op or IVDU ```

Answer 40

NF affecting perineal area | High mortality

Answer 41

Means that necrosis has destoyed peripheral nerves | Unlikely to improve with Ax

Answer 42

Amputtion | Death

Answer 43

Cellulitis - minimal systemic toxicity | Cutaneous anthrax - IVDU / animal contact and tends to be painless pruritic papule that go on to necrose

Emergency Dermatology Flashcards

(68 cards)