dermatological emergencies...dr. ian hoyle mbbs dip imc rcs (ed), da (uk),fracgp,facrrm,dip...

DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA

(UK),FRACGP,FACRRM,DIP DERM(Wales)

TASMANIAN SKIN AND BODY CENTRE

DERMATOLOGICAL EMERGENCIES

Dermatological Emergencies

INFECTIONS

ERYTHRODERMA

DRUG ERUPTIONS

STEVENS-JOHNSON SYNDROME AND TOXIC

EPIDERMAL NECROLYSIS

BLISTERING DISORDERS

NEUTROPHILIC DERMATOSES

URTICARIA AND ANGIOEDEMA

INFECTIONS - CELLULITIS

ERYSIPELAS

ECZEMA HERPETICUM

Herpes Zoster

PERIANAL ABCESS

MENINGOCOCCUS

Petechial rash with meningitis

NECROTISING FASCIITIS


Serious bacterial infection of soft tissues and fascia

Type 1 polymicrobial

Type 2 streptococcus

Type 3 gas gangrene clostridia

CLINICAL FEATURES

Usually starts as a minor injury

Worsening pain at the site of injury

Flu like symptoms

Dehydration

Purple rash at site of injury

Large dark marks forming blisters

Wound starts to die and blackens due to necrosis

Severe pain

Toxic shock

MANAGEMENT

ICU/HDU

IV Antibiotics

Surgical Debridement

Fluid balance

Renal and cardiovascular support

Hyperbaric Oxygen

Consideration of Intravenous Immunoglobulins

25% mortality

ERYTHEMA MULTIFORME

CAUSES OF ERYTHEMA MULTIFORME

HERPES SIMPLEX AND ZOSTER VIRUSES

MANY OTHER VIRUSES EG CMV HEPATITIS HIV

DRUG ERUPTION (< 10 % )

CLINICAL FEATURES EM minor

Usually preceded by infection such as cold sore or vaccination

Targetoid rash, mild fever and malaise

1-3 weeks

EM major rare, usually drug induced, more common withHIV

Mucosal eruptions and blisters lips,oropharynx,genetalia,conjunctivi

Fever and collapse

MANAGEMENT

MINOR

Symptomatic treatment – topical steroids , antihistamines

Anti virals for recurrent attacks

MAJOR

HDU - fluids, mouth care, avoid oral steroids

SEXUALLY TRANSMITTED DISEASE

PRIMARY SYPHILIS SECONDARY SYPHILIS

CLASSIFICATION OF BURNS

FIRST DEGREE SECOND DEGREE

BURNS

THIRD DEGREE FOURTH DEGREE

RULE OF 9’S

ERYTHRODERMA

Redness and scaling of almost all of the entire surface of the

skin

Causes of erythroderma

Drug eruption

Overwhelming Sepsis

Staph scalded skin

Eczema

PSORIASIS

ERYTHRODERMIC MYCOSIS

FUNGOIDES

PITYRIASIS RUBRA PILARIS

RED MAN (WOMAN) SYNDROME

INTERNAL MALIGNANCY

Complications of Erythroderma

Secondary Infections

Loss of Thermoregulation

High output Heart Failure

Fluid and Electrolyte imbalance

Renal Failure

Hypoalbuminaemia

MANAGEMENT

Wet dressings

Manage fluid balance and temperature

Anti biotics

Antihistamines

Aggressively Treat Underlying Condition

DRUG ERUPTIONS

ANY DRUG CAN CAUSE ANY RASH

ANTIBIOTICS

NON STEROIDAL ANTI INFLAMMATORIES

ASPIRIN

PARACETEMOL

ACE INHIBITORS

SEDATIVES EG BENZODIAZAPINES BARBITURATES

ALLOPURINOL

3% OF ALL ADMISSIONS HAVE A DRUG INDUCED

RASH

Generalised Morbilliform Rash

Drug induced erythema multiforme

Fixed Drug Eruption

Fixed drug Eruption

STEVENS JOHNSON SYNDROME AND

TOXIC EPIDERMAL NECROLYSIS

POTENTIALLY FATAL REACTION TO A DRUG – thought

to be a variation of the same condition

Fever, cough ,sore throat,runny nose,conjunctivitis,flu like

aches and pains

Evolving tender red skin rash- macules,targets and /or

blisters

Prominent Mucosal involvement eyes, lips, oropharynx,

genital area

Skin Desquamation with TEN >30% of Body SA

STEVENS-JOHNSON

Usually due to drugs esp. sulphonomides

nasaids,allopurinol,anticonvulsants

May present as generalised rash or erythema multiforme

STEVENS – JOHNSON SYNDROME

Mucosal involvement

Stevens - Johnson

CONJUNCTIVITIS

STEVENS-JOHNSON

BLISTERS

TOXIC EPIDERMAL NECROLYSIS

MANAGEMENT OF SJS AND TEN Cessation of the suspected drug

HDU/ICU

Fluid and electrolyte management

Temperature control

Analgesia

IV or Nasogastric nutrition

Skin,eye and mouth care

Physiotherapy to maintain joint movement and prevent pneumonia

Treatment of secondary Infection

Steroids contraversial

Anticoagulation

SYSTEMIC DISEASE

Systemic lupus Subacute lupus

Sytemic disease

scleroderma

Systemic disease

Dermatomyositis

Internal Malignancy

Erythema gyratum repens Leser trelat syndrome

BLISTERING SKIN DISEASE

SUBCORNEAL-very thin and fragile –Impetigo,miliaria,sss


Intra epidermal– thin roof ruptures easily- eczema,varicella,

pemphigus


Subepidermal- Tense roof- Bullous pemphigoid,dermatitis

herpetiformis,TEN

BLISTERING SKIN DISODERS

Bullous Pemphigoid

PEMPHIGUS

DERMATITIS HERPETIFORMIS

COELIAC DISEASE

EPIDERMOLYSIS BULLOSA

PEMPHIGUS GESTATIONIS

BULLOUS IMPETIGO


SWEETS DISEASE PYODERMA

GENGRENOSUM


ACUTE FEBRILE NEUTROPHILIC DERMATOSES

(SWEETS DISEASE)

Juicy pseudovesicular plaques

Fever,conjunctivitis,arthralgia

Arise in association with Infection, Malignancy and Drugs

Management-systemic steroids,topical steroids,dapsone

Withdraw any causitive drugs

PYODERMA GANGRENOSUM

Acute Ulceration with overhanging purple or black necrotic

edges

Common on Lower legs

Heals with cribriform scarring

Associated with Inflammatory Bowel Disease,Haematological

Malignancies and Rheumatoid Arthritis

Management-Treat underlying disease,Occlusive

dressings,Topical calcineurin ,Tetracycline

antibiotics,Ciclosporin

PYODERMA GANGRENOSUM

SWEET’S DISEASE


Acute – Lasts a few hours to six weeks eg infection, food ,

drugs. Sometimes associated with angioedema

Chronic- Lasts for > six weeks , sometimes life long-

considered an autoimmune disease in most cases.

DERMOGRAPHISM

ANGIOEDEMA


Management

Treat Underlying cause

Cooling moisturisers such as Aqueous cream with 1 %

menthol

Topical steroids – Betamethasone

Oral antihistamines

Pulsed Oral steroids

Immunosuppressant's - Ciclosporin

THANK YOU

dermatological emergencies...dr. ian hoyle mbbs dip imc rcs (ed), da (uk),fracgp,facrrm,dip...

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