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    Hippo Education Hippo EM - Dermatology Written Summary

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    kaylawilliam01
    1) Stevens-Johnson syndrome, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome are critical dermatologic emergencies characterized by painful blistering rashes requiring prompt treatment and admission. 2) Common infectious dermatologic emergencies include impetigo, tinea, herpes simplex, herpes zoster, molluscum contagiosum, scabies, and pediculosis, which are often diagnosed based on characteristic clinical presentations and treated with topical or oral antifungals, antivirals, or antiparasitics. 3) Dermatitis, psoriasis, seborrheic dermatitis,

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    Hippo Education Hippo EM - Dermatology Written Summary

    Uploaded by

    kaylawilliam01
    141 views7 pages
    1) Stevens-Johnson syndrome, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome are critical dermatologic emergencies characterized by painful blistering rashes requiring prompt treatment and admission. 2) Common infectious dermatologic emergencies include impetigo, tinea, herpes simplex, herpes zoster, molluscum contagiosum, scabies, and pediculosis, which are often diagnosed based on characteristic clinical presentations and treated with topical or oral antifungals, antivirals, or antiparasitics. 3) Dermatitis, psoriasis, seborrheic dermatitis,

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    1) Stevens-Johnson syndrome, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome are critical dermatologic emergencies characterized by painful blistering rashes requiring prompt treatment and admission. 2) Common infectious dermatologic emergencies include impetigo, tinea, herpes simplex, herpes zoster, molluscum contagiosum, scabies, and pediculosis, which are often diagnosed based on characteristic clinical presentations and treated with topical or oral antifungals, antivirals, or antiparasitics. 3) Dermatitis, psoriasis, seborrheic dermatitis,

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    141 views7 pages

    Hippo Education Hippo EM - Dermatology Written Summary

    Uploaded by

    kaylawilliam01
    1) Stevens-Johnson syndrome, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome are critical dermatologic emergencies characterized by painful blistering rashes requiring prompt treatment and admission. 2) Common infectious dermatologic emergencies include impetigo, tinea, herpes simplex, herpes zoster, molluscum contagiosum, scabies, and pediculosis, which are often diagnosed based on characteristic clinical presentations and treated with topical or oral antifungals, antivirals, or antiparasitics. 3) Dermatitis, psoriasis, seborrheic dermatitis,

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    of 7

    DERMATOLOGIC EMERGENCIES

    CRITICAL: Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Staph Scalded Skin Syndrome (SSSS), Necrotizing fasciitis

    SJS TEN SSSS


    YES MUCOSAL INVOLVEMENT YES MUCOSAL INVOLVEMENT NO MUCOSAL INVOLVEMENT
    MCC drugs >> HSV MCC drugs (sulfa) Kids <6 years old
    TARGET LESIONS, +NIKOLSKY, painful TARGET LESIONS, +NIKOLSKY, painful +NIKOLSKY, painful erythema, flaccid bullae
    Prodromal flu-like symptoms Prodromal flu-like symptoms Tx: Nafcillin/Dicloxacillin
    <10% BSA >30%BSA NO steroids!
    Tx: remove trigger, supportive, admit Tx: remove trigger, supportive, admit

    Mnemonics

    Sifting Rocks Scabbed EMmaʼs PALMS


    Syphilis (secondary), Rocky Mountain Spotted Fever, Scabies, Erythema Multiforme = PALMAR lesions

    Stevie got Scalded by TEN peeved (PVʼd) Nickels


    Stevens-Johnson, Staph Scalded Skin Syndrome, Toxic Epidermal Necrolysis, Pemphigus Vulgaris (PV)
    = POSITIVE Nikolsky sign

    Old man with BPPV fell into a pool of Necrotizing Gonorrhea


    Bullous pemphigoid (BP), Pemphigus Vulgaris (PV), Necrotizing fasciitis, Disseminated Gonorrhea
    (Vesicle/Bullae)

    NECROTIZING FASCIITIS Rocky Rick the tick gave Meningitis to DICk, the PURPLE drug addict
    Rocky Mountain Spotted Fever, Meningococcemia, DIC, Endocarditis (Petechiae/Purpura)
    S/S: pain out of proportion, hemorrhagic
    bullae, crepitance, rapid progression, dirty
    Lyme is an EMS TARGET
    dishwater discharge
    Lyme disease, Erythema Multiforme, Stevens-Johnson = TARGET lesions
    Tx: surgery, clindamycin
    Type 1 bacteria = polymicrobial (DM) Page 1
    Type 2 bacteria = GAS/MRSA
    DERMATOLOGIC EMERGENCIES
    MUST KNOW: Urticara, Erythema Multiforme, Pemphigus Vulgaris, Bullous Pemphigoid, Rocky Mountain Spotted Fever, Meningococcemia

    URTICARIA ERYTHEMA MULTIFORME ROCKY MOUNTAIN SPOTTED FEVER


    TRANSIENT lesions (<24 hours) FIXED lesions Rickettsia ricketsii via ticks (MC southeast US)
    Pruritic,edematous plaques, NOT symmetric NO MUCOSAL INVOLVEMENT Blanching maculopapular rash (palpable)
    Tx: remove trigger, supportive, recognize Hallmark = TARGET lesions, SYMMETRIC Starts wrists/ankles spreads centrally
    anaphylaxis (epinephrine +/- glucagon) Palms/Soles Tx: Doxycycline (high mortality if NOT treated)
    Tx: remove trigger, supportive

    PEMPHIGUS VULGARIS BULLOUS PEMPHIGOID MENINGOCOCCEMIA


    Older adult/elderly Elderly College, military barracks
    Flaccid bullae ➙ break easily & crust TENSE/FIRM bullae Evolving petechiae ➙ purpura, very ill/shock
    YES MUCOSAL INVOLVEMENT NO MUCOSAL INVOLVEMENT (purpura fulminans)
    POSITIVE NIKOLSKY NEGATIVE NIKOLSKY Tx: ceftriaxone, resuscitation
    Tx: steroids Tx: steroids
    PemphiguS = Superficial PemphigoiD = Deeper Page 2
    DERMATOLOGIC EMERGENCIES
    INFECTIONS

    MUST KNOW: Urticara, Erythema Multiforme, Pemphigus Vulgaris, Bullous Pemphigoid, Rocky Mountain Spotted Fever, Meningococcemia

    TOXIC SHOCK SYNDROME DISSEMINATED GONOCOCCEMIA IMPETIGO


    Fever + Hypotension + Erythroderma Assoc with tenosynovitis, septic arthritis CHILDREN
    ≥3 organ systems involved Erythematous/hemorrhagic papules ➙ Facial vesicles rupture ➙ honey crust
    Desquamating erythroderma pustules/vesicles with necrotic center (gun CONTAGIOUS
    YES MUCOSAL INVOLVEMENT metal gray); 10-20 total lesions Tx: TOPICAL mupirocin (small area) vs
    Trigger: tampon, surgical wounds Dx: culture genital/throat SYSTEMIC cephalexin (more extensive)
    Tx: remove source, broad-spec antibiotics Tx: ceftriaxone (Bullous impetigo = flaccid bullae)

    ERYSIPELAS CANDIDA TINEA


    Sharply demarcated cellulitis with raised Babies (diaper rash); Adults (intertriginous Sharply marginated, annular scaly lesions
    borders areas); HIV/chemo (oral thrush) with central clearing; pruritic
    Strep (GAS) Moist red macules/scaly rim, peripheral sat- Corporis (ringworm); Crura (jock itch); Pedis
    Tx: antibiotics ellite lesions (foot); Capitis (scalp); Unguium (nail)
    Tx: ORAL nystatin (thrush); TOPICAL azoles Tx: TOPICAL azoles for everything (except
    and keep dry (rash) scalp, nails) Page 3
    DERMATOLOGIC EMERGENCIES
    INFECTIONS

    HERPES SIMPLEX HERPES ZOSTER (shingles) HUMAN PAPILLOMA VIRUS


    Vesicular clusters with painful erosions UNILATERAL dermatome Anogenital warts
    HSV1 (1 mouth) = MC children Prodromal pain ➙ grouped vesicles Cauliflower-like, PAINLESS
    HSV2 (2 genitals) Elderly/immunocompromised Tx: referral; sexually transmitted
    Tx: acyclovir HUTCHINSON SIGN (herpes ophthalmicus) Vaccine available
    RAMSAY-HUNT syndrome (CN 7/8 palsy)
    Tx: self-limiting, acyclovir

    MOLLUSCUM CONTAGIOSUM SCABIES PEDICULOSIS (lice)


    Dome-shaped fleshy papule Interdigital web space, intertriginous areas Erythematous macules/wheals
    Central umbilication Extreme pruritis Extreme pruritis
    Children (daycare), Adult (STD), think HIV Tx = permethrin cream, ivermectin oral Kids (head lice); Adults (body lice)
    Tx: benign, self-limited, refer Norweigan scabies (immunocompromised) Tx: permethrin cream now and in 1wk
    Nits/lice = + Woodʼs lamp
    Page 4
    DERMATOLOGIC EMERGENCIES
    DERMATITIS

    ATOPIC DERMATITIS PSORIASIS SEBORRHEIC DERMATITIS


    Children <5 years old, h/o asthma/atopy Silvery scale/plaque Yellow greasy or dry white scales (dandruff)
    Flexural areas: dry, pruritic skin; lichenified Extensor areas; nail pitting/color changes Infants (cradle cap); Adults (scalp/eyebrow/
    Tx: emollients, topical steroids Tx: emollients, keratolytics, topical steroids forehead/ear/axilla/groin)
    Think HIV in adults
    Tx: topical antifungals, keratolytics, steroids

    CONTACT DERMATITIS
    DISCRETE rash (papules/vesicles/bullae)
    Contact trigger: direct irritant vs allergic rxn
    Tx: remove trigger, steroids (3wks for poison
    oak/ivy)

    Page 5
    DERMATOLOGIC EMERGENCIES
    MALIGNANCIES

    BASAL CELL CARCINOMA SQUAMOUS CELL CARCINOMA MELANOMA


    Pink pearly papule with telangiectasia ULCERATED center with firm-raised border ABCDE: Asymmetric, Borders (irregular),
    Sun-exposed areas (head/neck) Sun-exposed area (head/neck/arms) Color (mottled), Diameter (>6mm), Enlarged/
    Male >50 years old Tx: referral for biopsy elevated
    Tx: referral for biopsy Tx: referral for biopsy

    KAPOSI SARCOMA
    Red/purple papule/plaque
    PAINLESS, nonpruritic
    MC oral lesion (palate/gingiva)
    HIV/AIDS
    Tx: treat HIV

    Page 6
    DERMATOLOGIC EMERGENCIES
    OTHERS

    HEMANGIOMA LIPOMA SEBACEOUS CYST


    Infant/child Well-circumscribed, mobile, painless Central punctum; cottage cheese discharge
    HEAD >> trunk > ext Asymptomatic, normal overlying skin Asymptomatic although can be secondarily
    Blanching “ripe strawberry” nodule SLIPPAGE SIGN infected
    50% resolve by age 5years Tx: benign; referral for excision NO slippage sign
    Tx: referral Tx: benign; referral for excision

    DECUBITUS ULCER ERYTHEMA NODOSUM PITYRIASIS


    ICU, elderly, paraplegic PAINFUL red/violet nodules HERALD PATCH ➙ Christmas-tree rash pat-
    Stage 1: intact skin w/ nonblanching erythema “Looks like a bruise” tern to trunk; rash can be pruritic
    Stage 2: partial thickness loss of dermis ANTERIOR TIBIA Prodromal flu-like illness
    Stage 3: full thickness loss exposing SQ fat 20-50yo female Tx: self-limited
    Stage 4: exposed bone/tendon/muscle Tx: supportive
    Tx: wound care, consultation as needed
    Page 7

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