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Questions and Answers

What is the primary objective of describing the defining characteristics of various skin lesions?

To understand the importance of travel history in patient assessment

To develop a treatment plan for dermatologic emergencies

To differentiate between erythematous, maculopapular, petechial, and vesiculobullous rashes (correct)

To identify the most deadly rashes

What is a crucial aspect of patient history in dermatologic emergencies?

Travel history (correct)

Family medical history

Medication allergies

Duration of symptoms

What is the most common association of Toxic Epidermal Necrolysis (TEN)?

Anticonvulsants

NSAIDs

Sulfa drugs (correct)

Antivirals

What can also induce Toxic Epidermal Necrolysis (TEN)?

Infection Signup and view all the answers

What is a characteristic of the most deadly rashes?

They progress rapidly, within hours or minutes Signup and view all the answers

What is the term for a rash characterized by small bumps?

Maculopapular Signup and view all the answers

What is a characteristic of the onset of Toxic Epidermal Necrolysis (TEN)?

Sudden onset Signup and view all the answers

What is the term for a rash characterized by fluid-filled lesions?

Vesiculobullous Signup and view all the answers

Approximately what percentage of cases of Toxic Epidermal Necrolysis (TEN) involve mucosal involvement?

90% Signup and view all the answers

What is the primary focus of an algorithmic approach to dermatologic emergencies?

Developing a differential diagnosis Signup and view all the answers

What is the underlying mechanism of Toxic Epidermal Necrolysis (TEN)?

Cytotoxin-mediated keratinocyte apoptosis Signup and view all the answers

What is a characteristic of the rash in the case of Eva, the 15-year-old patient?

It progressed rapidly within 8 hours Signup and view all the answers

What is the percentage of idiopathic cases of Toxic Epidermal Necrolysis (TEN)?

1/3 Signup and view all the answers

What is the term for a rash characterized by purplish spots or patches?

Petechial Signup and view all the answers

What is the primary treatment for Toxic Epidermal Necrolysis (TEN)?

Cessation of offending drug if known and wound care Signup and view all the answers

What is a possible long-term complication of Toxic Epidermal Necrolysis (TEN)?

Severe scarring Signup and view all the answers

What is the mortality rate for Toxic Epidermal Necrolysis (TEN)?

10-70% Signup and view all the answers

What type of history is important to ask about when evaluating a patient with a rash?

Medical or occupational history Signup and view all the answers

What is the typical age range affected by Staphylococcal Scalded Skin Syndrome (SSSS)?

Children younger than 5 years Signup and view all the answers

What is a characteristic presentation of Staphylococcal Scalded Skin Syndrome (SSSS)?

Rash that blisters and sloughs Signup and view all the answers

What medication-related factor should be considered when evaluating a patient with a rash?

Self-treatment that may alter rash morphology Signup and view all the answers

What is a key physical exam finding in patients with toxic epidermal necrolysis?

All of the above Signup and view all the answers

What is the primary causative agent of Staphylococcal Scalded Skin Syndrome (SSSS)?

S. aureus Signup and view all the answers

What is characteristic of the early eruption of toxic epidermal necrolysis?

Dusky red macules that progressively coalesce Signup and view all the answers

What is the mortality rate for Staphylococcal Scalded Skin Syndrome (SSSS) in adults with appropriate treatment?

60% Signup and view all the answers

What is a complication of toxic epidermal necrolysis?

All of the above Signup and view all the answers

What is a possible complication of Staphylococcal Scalded Skin Syndrome (SSSS)?

Pneumonia Signup and view all the answers

What is the term for the sign where the roof of a blister is dusky in color, suggesting necrosis of the epidermis?

Dusky blister roof sign Signup and view all the answers

What is the term for the advanced eruption of toxic epidermal necrolysis?

Complete epidermal necrolysis Signup and view all the answers

What is the name of the syndrome that toxic epidermal necrolysis is often associated with?

Stevens-Johnson syndrome Signup and view all the answers

Study Notes

Dermatologic Emergencies

Describe the defining characteristics of various skin lesions
Review important historical elements in patients with dermatologic complaints
Describe symptoms, signs, and physical exam findings in some emergent dermatologic conditions

Case Study: Eva

15-year-old girl developed flu-like symptoms with a fever of 99.5°F
Took acetaminophen and woke up with redness and blisters covering her face, which spread to shoulders and the rest of the body within 8 hours
Skin around her eyes sloughed off on the doctor's fingertips
Within 24 hours, sloughing occurred on the neck, shoulders, stomach, and back

Formulating a Differential Diagnosis

Erythematous Rash: redness/inflammation
Maculopapular Rash: small bumps
Petechial/Purpuric Rash: purplish spots or patches
Vesiculobullous Rash: fluid-filled lesions

Important Patient Historical Components

Distribution and progression: peripheral, central, localized, or rapidly progressive
Travel history: Caribbean/Mexico/South Florida/Louisiana (Dengue), camping/hiking (tick-borne illness)
Medical or occupational history: DM, chemotherapy, HIV, IV drug use
Medications: potentially lethal drug reactions, self-treatment altering rash morphology

Physical Exam Pointers

Fever
Mucous membrane involvement
Nikolsky's sign
Sick or not sick

Toxic Epidermal Necrolysis (TEN)

Most serious cutaneous drug reaction
Associated with sulfa drugs, anticonvulsants, antivirals, and NSAIDs
Can be induced by infection (mycoplasma) or idiopathic (1/3 of cases)
Presents with sudden onset of diffuse erythema, tender skin, and sloughing
Mucosal involvement in 90% of cases
Widespread keratinocyte apoptosis is cytotoxin-mediated
Treatment: cessation of offending drug, wound care, eye care, electrolyte and fluid resuscitation
Prognosis: long-term complications include scarring, alopecia, mucosal sloughing, ocular damage, or blindness; mortality is 10-70%

Staphylococcal Scalded Skin Syndrome (SSSS, Ritter's Disease)

More common in children younger than 5 years
Presentation: scarlatiniform, erythematous rash that blisters and sloughs (positive Nikolsky sign), abrupt fever, erythema often of the neck, axillae, and groin, and extreme skin tenderness
Pathophysiology: exfoliative skin toxin produced by 5% of S. aureus
Diagnosis: clinical diagnosis confirmed by Staph positive blood cultures
Treatment: antistaphylococcal antibiotics, fluid and electrolyte replacement, wound care
Prognosis: early treatment can prevent serious complications; in adults, condition is rare but has a 60% mortality with appropriate treatment; in children, mortality is low

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