DERMATOLOGICAL EMERGENCIES. DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE
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1 DERMATOLOGICAL EMERGENCIES DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE
2 Dermatological Emergencies INFECTIONS ERYTHRODERMA DRUG ERUPTIONS STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS BLISTERING DISORDERS NEUTROPHILIC DERMATOSES URTICARIA AND ANGIOEDEMA
3 INFECTIONS - CELLULITIS
4 ERYSIPELAS
5 ECZEMA HERPETICUM
6 Herpes Zoster
7 PERIANAL ABCESS
8 MENINGOCOCCUS
9 Petechial rash with meningitis
10 NECROTISING FASCIITIS
11 NECROTISING FASCIITIS Serious bacterial infection of soft tissues and fascia Type 1 polymicrobial Type 2 streptococcus Type 3 gas gangrene clostridia
12 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
13 MANAGEMENT ICU/HDU IV Antibiotics Surgical Debridement Fluid balance Renal and cardiovascular support Hyperbaric Oxygen Consideration of Intravenous Immunoglobulins 25% mortality
14 NECROTISING FASCIITIS
15 ERYTHEMA MULTIFORME
16 CAUSES OF ERYTHEMA MULTIFORME HERPES SIMPLEX AND ZOSTER VIRUSES MANY OTHER VIRUSES EG CMV HEPATITIS HIV DRUG ERUPTION (< 10 % )
17
18
19 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
20 MANAGEMENT MINOR Symptomatic treatment topical steroids, antihistamines Anti virals for recurrent attacks MAJOR HDU - fluids, mouth care, avoid oral steroids
21 SEXUALLY TRANSMITTED DISEASE PRIMARY SYPHILIS SECONDARY SYPHILIS
22 BURNS
23 CLASSIFICATION OF BURNS FIRST DEGREE SECOND DEGREE
24 BURNS THIRD DEGREE FOURTH DEGREE
25 RULE OF 9 S
26 ERYTHRODERMA Redness and scaling of almost all of the entire surface of the skin
27 Causes of erythroderma Drug eruption
28 Overwhelming Sepsis Staph scalded skin
29 Eczema
30 PSORIASIS
31 ERYTHRODERMIC MYCOSIS FUNGOIDES
32 PITYRIASIS RUBRA PILARIS
33 HIV
34 RED MAN (WOMAN) SYNDROME
35 INTERNAL MALIGNANCY
36 Complications of Erythroderma Secondary Infections Loss of Thermoregulation High output Heart Failure Fluid and Electrolyte imbalance Renal Failure Hypoalbuminaemia
37 MANAGEMENT Wet dressings Manage fluid balance and temperature Anti biotics Antihistamines Aggressively Treat Underlying Condition
38 DRUG ERUPTIONS
39 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
40 Generalised Morbilliform Rash
41 Drug induced erythema multiforme
42 Fixed Drug Eruption
43 Fixed drug Eruption
44 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
45 STEVENS-JOHNSON Usually due to drugs esp. sulphonomides nasaids,allopurinol,anticonvulsants May present as generalised rash or erythema multiforme
46 STEVENS JOHNSON SYNDROME Mucosal involvement
47 Stevens - Johnson CONJUNCTIVITIS
48 STEVENS-JOHNSON BLISTERS
49 TOXIC EPIDERMAL NECROLYSIS
50 TEN
51 TEN
52 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
53 SYSTEMIC DISEASE Systemic lupus Subacute lupus
54 Sytemic disease scleroderma
55 Systemic disease Dermatomyositis
56 Internal Malignancy Erythema gyratum repens Leser trelat syndrome
57 BLISTERING SKIN DISEASE SUBCORNEAL-very thin and fragile Impetigo,miliaria,sss
58 BLISTERING SKIN DISEASE Intra epidermal thin roof ruptures easily- eczema,varicella, pemphigus
59 BLISTERING SKIN DISEASE Subepidermal- Tense roof- Bullous pemphigoid,dermatitis herpetiformis,ten
60 BLISTERING SKIN DISODERS Bullous Pemphigoid
61 PEMPHIGUS
62 DERMATITIS HERPETIFORMIS
63 COELIAC DISEASE
64 EPIDERMOLYSIS BULLOSA
65 PEMPHIGUS GESTATIONIS
66 BULLOUS IMPETIGO
67 BURNS
68 NEUTROPHILIC DERMATOSES SWEETS DISEASE PYODERMA GENGRENOSUM
69 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
70 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
71 PYODERMA GANGRENOSUM
72 SWEET S DISEASE
73 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 longconsidered an autoimmune disease in most cases.
74 URTICARIA AND ANGIOEDEMA
75 DERMOGRAPHISM
76 ANGIOEDEMA
77 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
78 THANK YOU
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