Derm Emergencies

Question 1

What is Urticaria?

Answer 1

AKA hives
- Raised, itchy
- Caused by histamine (allergies)
- Usually uncomplicated

Question 2

What is the treatment for urticaria (hives)?

Answer 2

Anti-histamines
Eg. Fexofenadine

Question 3

What are the causes of erythema nodosum?

Answer 3

• Group A beta-haemolytic streptococcus
  – Primary tuberculosis
  – Pregnancy
  – Malignancy
  – Sarcoidosis
  – IBD
  – Chlamydia
  – Leprosy

Question 4

What is Erythema nodosum?

Answer 4

A hypersensitivity reaction
- Most common on shins
- Tender nodules that may merge
- Leave bruise-like discolouration as they resolve
- Don’t cause scarring

Question 5

How is erythema nodosum managed?

Answer 5

• Resolves by itself
• Target the possible cause
• NSAID can reduce discomfort

Question 6

What is erythema multiforme?

Answer 6

An acute, self-limiting inflammatory condition
Causes:
- Infection (90%) Eg. mycoplasma, HSV
- Unknown
- Drugs

Question 7

What is the treatment for erythema multiforme?

Answer 7

• Treat the cause
  Eg. aciclovir, antibiotics
• Supportive care

Itch: antihistamines
Oral pain: anaesthetic/antiseptic mouthwash
Eyes: refer to ophthalmology

Question 8

What is Steven-Johnson syndrome?

Answer 8

An over-reaction of the immune system to infection or medication
- Painful rash
Treatment: supportive

Causes:
- Drugs (40% antibiotics)
- Infections Eg. mycoplasma pneumoniae, CMV, vaccines, systemic disease, radiotherapy, bone marrow transplant

Question 9

What is shown on histology of Steven-Johnson syndrome?

Answer 9

Epithelial necrosis with some inflammatory cells

Question 10

What is the difference between Steven-Johnson syndrome and toxic epidermal necrosis?

Answer 10

Toxic epidermal necrosis has a prodromal illness resembling an URTI
Eg. sore throat, fever, runny nose, cough, sore eyes, aches and pains

Question 11

What is toxic epidermal necrosis?

Answer 11

Usually a drug-induced reaction causing skin and mucosal necrosis and accompanied systemic toxicity

Question 12

How does toxic epidermal necrosis
(TEN) present?

Answer 12

• Prodromal URTI-like symptoms
• Sudden, painful red rash starting at the trunk spreading over hours
• Rash rarely affects scalp, palms and soles of feet

Skin lesions may be macules (measles0like), diffuse erythema, targetoid (like erythema multiforme), or like blisters

Question 13

What is the SCORTEN criteria?

Answer 13

Severity-of-Illness Score for Toxic Epidermal Necrolysis

Question 14

What is erythroderma?

Answer 14

• Very inflamed and scaly skin
• Systemically unwell, lymphadenopathy, malaise

Causes:
- Previous skin disease (eczema, psoriasis)
- Drugs (sulphonamides, penicillin, allopurinol)

Question 15

How is Erythroderma managed?

Answer 15

• Treat underlying cause
• Emollients and skin wrap to maintain skin moisture
• Topical steroids

Question 16

What are the complications of erythroderma?

Answer 16

• Secondary infections
• Fluid loss and electrolyte imbalance
• Hypothermia
• High output cardiac failure

(High mortality)

Question 17

What is eczema herpeticum?

Answer 17

Eczema infected is herpes simplex
- Appears rapidly
- Need admission if on the face (can have ophthalmic complications)