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
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
NECROTISING FASCIITIS
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
BURNS
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
HIV
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
TEN
TEN
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
BLISTERING SKIN DISEASE
Intra epidermal– thin roof ruptures easily- eczema,varicella,
pemphigus
BLISTERING SKIN DISEASE
Subepidermal- Tense roof- Bullous pemphigoid,dermatitis
herpetiformis,TEN
BLISTERING SKIN DISODERS
Bullous Pemphigoid
PEMPHIGUS
DERMATITIS HERPETIFORMIS
COELIAC DISEASE
EPIDERMOLYSIS BULLOSA
PEMPHIGUS GESTATIONIS
BULLOUS IMPETIGO
BURNS
NEUTROPHILIC DERMATOSES
SWEETS DISEASE PYODERMA
GENGRENOSUM
NEUTROPHILIC DERMATOSES
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
URTICARIA AND ANGIOEDEMA
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.
URTICARIA AND ANGIOEDEMA
DERMOGRAPHISM
ANGIOEDEMA
URTICARIA AND 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