Lecture 3 Acute & Emergency Dermatology Flashcards
(44 cards)
Consequence of mechanical barrier to infection
Sepsis
Consequence of failure of temperature regulation
Hypo-Hyperthermia
Consequence of failure of fluid and electrolyte balance
Protein and fluid loss
Renal impairment
Peripheral vasodilation
Causes of erythoderma
Psoriasis Eczema Drugs Cutaneous lymphoma hereditary disorders Unknown
Management of Erythroderma
- Remove any offending drugs
- Careful fluid balance
- Good nutrition
- Temperature regulation
- Emollients – 50:50 Liquid Paraffin : White Soft Paraffin
Mild drug reaction
Morbilliform exanthem
Macular rash, similar to measles
Severe drug reaction
Erythroderma, Stevens Johnson Syndrome/Toxic epidermal necrolysis, DRESS
Secondary causes of SJS
NSAIDs Antibiotics Anticonvulsants Allopurinol NSAIDs onset can be delayed
Clinical features of SJS
• Fever • Malaise • Arthralgia • Rash – Maculopapular, target lesions, blisters – Erosions covering <10% of skin surface • Mouth ulceration – Greyish white membrane – Haemorrhagic crusting • Ulceration of other mucous membranes • Painful • Dusky Skin sloughing • Lung involvement- CXR
Clinical Features of Toxic Epidermal Necrlysis
• Often presents with prodromal febrile illness
• Ulceration of mucous membranes
• Rash
– May start as macular, purpuric or blistering
– Rapidly becomes confluent
– Sloughing off of large areas of epidermis – ‘desquamation’ > 30% BSA
– Nikolsky’s sign may be positive- minor trauma removes epidermis
Management of severe drug reactions
- Identify and discontinue culprit drug
* Supportive therapy
How is the prognosis of severe drug reactions scored
SCORTEN criteria
What is SCORTEN criteria
– Age >40 – Malignancy – Heart rate >120 – Initial epidermal detachment >10% – Serum urea >10- dehydrated – Serum glucose >14- hyperglycaemic – Serum bicarbonate <20- highly acidic
SCORTEN 0-1
> 3.2% mortality
SCORTEN 2
> 12%
SCORTEN 3
> 35%
SCORTEN 4
> 58%
SCORTEN 5 or more
> 90%
Long term compilation of severe drug reactions
– Pigmentary skin changes – Scarring- genital sites – Eye disease and blindness – Nail and hair loss – Joint contractures- if scarring causes keloids
What causes erythema Multiforme
• Hypersensitivity reaction usually triggered by infection
– Most commonly HSV, then Mycoplasma pneumonia
Clinical features of Erythema Multiforme
• Abrupt onset of up to 100s of lesions over 24 hours
– Distal proximal
– Palms and soles
– Mucosal surfaces (EM major)
– Evolve over 72 hours
• Pink macules, become elevated and may blister in centre
• “Target” lesions
How is Erythema Multiforme managed
- Self limiting and resolves over 2 weeks
- Symptomatic and treat underlying cause
- More common in children and younger patients
Clinical features of DRESS
- Macules on skin
- Fever, lymphadenopathy, abnormal LFTs
- Eosinophilia
- DIC (Disseminated Intravascular Coagulation)
- Acute renal failure
Treatment of DRESS
- Stop causative drug
- Symptomatic and supportive
- Systemic steroids
- +/- Immunosuppression or immunoglobulins
