DERMATOLOGICAL EMERGENCIES. DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE

DERMATOLOGICAL EMERGENCIES DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE

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 longconsidered 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

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