Beruflich Dokumente
Kultur Dokumente
(KEGAWATDARURATAN KULIT)
Dermatologic Emergencies
Aetiology &
Management
patophysiology
Complication Diagnosis
Skin lesion type
Primary:
Macule
Papule
Nodule
Plaque
Pustule
Vesicle
Bulla
Petechiae
Purpura
Secondary :
Erosion
Excoriation
Ulcer
Crust
Lichenification
Atrophy
Macule Patch
Papule Nodule
pustule
Papul Plaque
Vesicle Bulla
Petechie, purpura
STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL
NECROLYSIS
ERYTHRODERMA/EXFOLIATIVE DERMATITIS
Etiology:
Drugs:
sulfonamide, carbamazepin, phenobarbitone, carbamazepine, sodium
valproate, allopurinol, oxicam NSAIDS, diclofenac, lamotrigine, nevirapine
Patophysiology:
Cell mediated cytotoxic reactions againts keratinocyte massive
apoptosis epidermal necrosis detachment of epidermis
Anamnesis:
History of taking the drug 4-30 days (8 weeks) before the appearance of
clinical symptom.
Non specific symptom may precede the mucocutaneous lesion by 1-3
days.
Skin lesion:
Early eruption:
erythematous dusky red
macules
Mucous membrane
Advance eruption: involvement: at least
blisters, epidermal at 2 sites buccal,
detachment ocular, genital mucosa
Etiology:
Autoimmune reactions
Patophysiology:
Immunoglobulin G direct againt the cell surface of
keratinocytes separation of edipermal cells from
each other acantholysis intraepidermal blistering
Skin lesions:
Erosion/ulceration of oropharynx
stomatitis
Cutaneous lesions: blisters, ruptured
easily leaving erosion.
Laboratory Test
Routine blood count, serum chemistries
Skin biopsy for hystology
Immunofluoresence
Complication
Sepsis
Management
Skin & mouth care wound dressing
Treatment of secondary Infection
Corticosteroid
Staphylococcal Scalded Skin Syndrome
(SSSS/S4)
Etiology:
Exfoliative toxin of S. aureus
Patophysiology:
Exfoliative toxin (serin proteases) bind to cell
adhesion molecule desmoglein I and cleave it loss of
cell-cell adhesion epidermolysis between strat
spinosum strat granulosum
Skin lesions:
Erythema local or generalized
Tenderness
Bullae very thin walled flaccid bulae
Exfoliation
Nikolsky sign (+)
Laboratory Test
Routine blood count, serum chemistries
Skin biopsy for hystology
Immunofluoresence
Complication
Fluid & electrolyte disturbances
Sepsis
Management
Fluid & electrolyte
Intravenous antibiotic
Topical mupirosin ointment
Skin care
Differential Diagnosis
Steven Johnson Syndrome Pemphigus Staphylococcal Scalded Skin Syndrome
Etiology:
Psoriasis
Atopic dermatitis
Other spongiotic dermatoses
Drug hypersensitivity reaction
Cutaneous T-Cell Lymphoma
Idiopathic (20%)
Patogenesis:
related to the patogenesis of underlying disease
Skin lesions:
Complication
Fluid & electrolyte imbalances
Thermoregulatory disturbance
High out put cardiac failure
Renal failure
Secondary Infection
Hypoalbuminemia
Management
First line
Fluid & electrolyte replacement
High calorie high protein dietary, folate supplementation
Antihistamin
Systemic antibiotic if secondary infection
Diuretics for peripheral edema
Environment should be warm & humid
Emolient, low potency topical corticosteroid
Second line
Corticosteroid, methotrexate, etc
Acute Urticaria & Angioedema
Etiology:
Drug, food , infection
Patophysiology:
Mast cell degranulation & histamine release
Edema:
superficial dermis urticaria
deep dermis/subcutaneous/submucosal angioedema
Skin lesions:
Wheals, angioedema
Itchy/pruritus
Management
Antihistamin: diphenhydramine 25-50mg (iv/im)
Corticosteroid : methylprednisolone 40-60 mg/day, for 3
days tapper by 10 mg/day
Cooling moisturisers
Identification & elimination of endo/exogenous causes