(686709895) dermatologic_emergencies2.pptx

7/24/2019 (686709895) Dermatologic_Emergencies2.pptx

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Dermatologic Emergencies


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Pemphigus Vulgaris (PV)-Serious bullous autoimmune disease

-Involves skin and mucous membranes

-Often fatal unless treated ith steriods !immunosuppressive drugs

-"ge# $% to &%

-Etiolog' # autoimmune

-an start in mouth then skin or generalied acute

eruption of both

-Painful mouth erosions (ma' affect food intake)


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intercellular space in epidermis

against desmoglein III

PV- Skin *esions # +laccid bullaeeasil' ruptured ,

erosions bleeding .

crustation- /ikol'sk'0s sign # Positive

- Skin 1iops'#

Intraepidermal blister

ith acanthol'sis(separation ofkeratinoc'te from eachother)

- Immunoflourscence 2 (I+)(Patient skin ) Direct#


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PVourse# - an be fatal unless treated aggressivel'

ith immunosuppressive agents

Variants#-Pemphigus Vegetans# Intertiginous areas ith

vegetating lesions

- Pemphigus +oliaceous # Er'thematous patches

and erosions covered ith crustations

-Pemphigus er'thematosus# er'thematous crusted

erosive lesions in the butterfl' area of face forehead. chest "/" ! Ve


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PV-Drug Induced pemphigus

D- Pencillamine

aptopril

-Paraneoplastic pemphigus# "ssociated ith

malignanc'

5anagement#-orrection Of +luid . electrol'te loss

-treatment of infection b' antibiotics

-s'stemic steriods (high dose)


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PV

6 -immunosuppersive therap'(given ith

steroids)

6 "athiopurine6 5ethotr7ate

6 'clophosphamide

-Plasmapharesis


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1ullous Pemphigoid (1P)"ge# &% to 8% 'rs

Often starts as urticarial lesions , bullae

or directl' as bullous eruptionSkin findings#

*arge tense intact bullae

Involvement#

skin5ucous membrane (less than pemphigus)

Skin 1iops'#

Subepidermal blisters ith

eosinophils


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1PImmunofluroscence#

-Direct # *inear deposition of Ig3 . 4(along the

basement membrane)-Indirect # autoantibodies against 1P"g9 .1P"g:

-5anagement #-superpotent topical steroids (for mild cases)- Systemic steroids

- + Immunosuppressive agents

Prognosis: Better than PV


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ompare PV . 1P ;

- 5orpholog'

- 5ucous membrane involvement

- skin biops' . I+

- Prognosis


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m'coplasma)

Steven0s =ohnson S'ndrome and >o7ic

Epidermal /ecrol'sis (S=S and >E/)

Etiolog'#

>E/# mostl' due to drug

S=S# due to drugs or infections (commonl'

Drugs#

Sulfa group

"llopurinol

"ntiepileptics (carbamapine and phen'toin)Penicillin?sephalosporins

/S"IDs


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S=S @ >E/

Definition# 1oth can start as target lesion then

diffuse er'thema skin necrosis and detachment

S=S A 9%B epidermal detachment

S=S @ >E/ overlap 9% C 4% B>E/ 4%B epidermal detachment

>ime from first drug e7posure to onset ofdisease is

9 to 4 eeksProdrome# +ever . fluClike

Skin Pain burning . tenderness

5ucous membrane # mouth lesions are painful andtender<


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S=S @ >E/

-*esions can start as macular er'thema and target

lesions then detachment of skin

-In >E/ # !Ve /ilolsk'0s sign

-5ucous membrane er'thema painful erosions ofmouth conunctiva genital and anal skin

-+ever malaise acute renal failure

-omplications2

-+luid and electrol'te imbalance-Infection (due to loss of skin barrier)

-Skin# Scarring and d'spigmentation

-E'e# "dhesions , blindness

-"cute renal failure


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S=S @ >E/

-Diagnosis confirmation # skinbiops'

-5ortalit'#

-In >E/ 4%B-In S=S A FB

Gauses of Death

- Sepsis

- 3I> bleed

- +luid @Electrol'te

imbalance


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S=S @ >E/5anagement#

- Stop the causativeagent

- "dmit to burn unit or

IH- IV+ and electrol'te replacement like

burn patient

- IV "b7 for infection

- Skin dressing dail'

- E'e care b' opthalmologist dail'

- igh calori intake

- +ol'0s catheter@ /3 tube


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S=S @ >E/

-Intravenous immunoglobulins (ver' useful)

-; S'stemic steroid (controversial)

-Plasma e7change

-Prevention # In future patient must not take the

causative drug or other drugs hich can cause

cross-reactionh'roto7icosis S*E

and *'mphoma

6 5anagement#- omplete h7 . e7amination are important

- Inv7# 1asic# 1 . D ESJ *+> H@"

- "dditional "ccording to h7 and e7am#epatitis 1. th'roid function test th'roid

antibodies "/"


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"cute Hrticaria

onsider "llergen >esting # Prick test

J"S>

>reatment#

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(686709895) dermatologic_emergencies2.pptx

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