This document discusses emergency dermatology situations that require prompt management. It focuses on three main areas: severe drug reactions like toxic epidermal necrolysis which requires immediate drug cessation; serious infections like meningococcal disease signaled by palpable purpura that needs rapid antibiotics; and erythroderma involving over 90% of body surface that can cause systemic issues like fluid/electrolyte imbalance. Early recognition and treatment of these conditions is important to minimize patient harm.
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A discussion on various photodermatoses including sun burns, porphyria, actinic chelitis, hydroa vacciniforme and chronic actinic dermatitis. Sun tan and skin color types. Affect of Sunlight on the skin. Useful for medical residents, dermatologists and nurse. Useful in exam preparation.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
This presentation contains the Definition of Eczema, Histology ,Classification ,Clinical manifestation, Differential Diagnosis, Complication, Investigation ,Treatment. it covers briefly the topic related with eczema so the reader will be able to study all aspects related with eczema
A discussion on various photodermatoses including sun burns, porphyria, actinic chelitis, hydroa vacciniforme and chronic actinic dermatitis. Sun tan and skin color types. Affect of Sunlight on the skin. Useful for medical residents, dermatologists and nurse. Useful in exam preparation.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
This presentation contains the Definition of Eczema, Histology ,Classification ,Clinical manifestation, Differential Diagnosis, Complication, Investigation ,Treatment. it covers briefly the topic related with eczema so the reader will be able to study all aspects related with eczema
DARIER’S DISEASE, Keratosis folliculiris, rare genetic disorder that is manifested predominantly by skin changes, due to ATP2A2 mutation, The histology is characteristic, known as focal acantholytic dyskeratosis associated with varying degrees of papillomatosis
Paget's disease of the breast is an extremely challenging problem. It not only poses a diagnostic dilemma but a therapeutic as well. The paper describes the diagnostic and therapeutic challenges.
Cutaneous manifestations of internal malignancy and paraneoplastic syndromes gamal sultan
cutaneous manifestations are extremely valuable marker because they may well be the presenting manifestation of an underlying neoplasm.
Increased clinician awareness could prove beneficial for the patient by promoting earlier screening and diagnosis, as well as increased intervention measures, thereby significantly affecting the chances of survival and/or improving the quality of life of the patient
Drug induced skin disorders is defined as any skin disorders caused by a drug or medication. It is estimated that 2—3 percent of hospitalised patients are affected by a drug eruption, and that serious drug eruptions occur in around 1 in 1000 patients.
Drug induced dermal disorders ppt by Salva SafdarPARUL UNIVERSITY
The skin is the largest organ in the body, and adverse skin reactions due to drug exposure are a common problem.
The exact mechanism for many of the drug-induced skin diseases is not fully understood and may result from both immune and non-immune mechanisms.
This is a lecture given at the American University of Beirut for medical students during their dermatology rotation as an elective.
It is an introductory lecture about skin inflammatory diseases.
2. Emergency Dermatology
Emergencies are rare in general dermatology but there are
certain situations that require prompt management.
These include severe drug reactions, severe
infections, allergic reactions and severe flares of
inflammatory dermatoses.
3. The following three areas will be briefly discussed.
Severe drug reactions
Serious infections
Erythroderma
4. Serious drug reactions
Drug reactions in the skin are usually innocuous and self-
limiting.
The most common presentation is of a blotchy erythema
predominantly involving the trunk. This may be referred
to as a “morbilliform” (measles-like) rash or as a
“macuo-papular” rash. This presentation can also be
referred to as a toxic erythema, this is discussed in
another module.
However, medications can produce many other types of
skin changes including
urticaria, erythema mutliforme, lichenoid changes,
pustules, pigmentation, blisters and mucosal changes
6. The list of medications that can cause drug reactions is
extremely long, but the most common medications
causing drug reactions are
Antibiotics – beta lactams, sulphonamides
Anticonvulsants – phenytoin, carbamazepine,
lamotrigine
Cardiac medications – frusemide, thiazide diuretics,
ACE inhibitors
Nonsteroidal anti-inflammatories
Allopurinol
Antiretrovirals
7. The most serious drug reaction is toxic epidermal
necrolysis. A severe type IV hypersensitvity reaction
causes widespread skin necrosis and can lead to
multiorgan failure and overwhelming sepsis.
It needs early recognition, immediate cessation of the
offending drug and early intensive supportive
management. It is an emergency.
Important signs of a potentially more serious drug reaction
are
fever and systemic upset
mucous membrane involvement
targetoid lesions with central duskiness or blistering
skin pain and tenderness
blistering and shedding of sheets of epidermis
11. Serious infections
Ocassionally cutaneous findings are an early feature of
serious infections. Usually other systemic findings will
aid in early diagnosis.
A classic example is meningococcal disease, caused by
the bacteria Neisseria meningitidis.
This needs early antibiotic treatment. A delay of just hours
can be fatal.
The hallmark is palpable purpura – due to vasulitis and
vascular occlusion and damage.
14. Other examples of severe cutaneous reactions in infections
occur in Kawasaki disease and Staphylococcal Scalded
Skin Syndrome.
Kawasaki disease is defined by fevers, a widespread
exanthem, conjunctivitis, mucositis and
lymphadenopathy.
Staphylococcal Scalded Skin Syndrome comprises
irritability, fevers and widespread erythema developing
into blisters and then skin changes like a burn
16. Erythroderma
This is erythema involving 90% or more of the body surface
area.
It often necessitates admission as patients are systemically
unwell. Older patients are especially prone to fluid
loss, electrolyte imbalance, cardiac failure and
hypothermia.
The most common causes are
psoriasis
dermatitis
drug reactions
pityriasis rubra pilaris
lymphoma
In approximately 10%, no cause can be identified.
20. Conclusion
Like all of these modules, this is a very brief introduction to
some skin conditions that must be recognized early to
minimize patient harm.
There are certain dermatological conditions that must be
treated early to prevent significnat morbidity or even
mortality.