focussed discussion on dermatological emergencies by emergency physicians largely tintinalli based

1. Dermatological emergencies
Murtuza Ghiya,
Assistant professor, Emergency Medicine

2. 1
• All of the following have been associated with the development of
Stevens-Johnson syndrome EXCEPT
• (A) systemic steroids
• (B) mycoplasma
• (C) herpes simplex virus
• (D) anticonvulsants
• (E) a seasonal profile

3. • The answer is A.
• Steroids have not been associated with Stevens- Johnson syndrome
(SJS).
• Nearly 50 percent of cases of SJS are considered to be idiopathic.
• Implicated agents include mycoplasma, herpes simplex viruses,
malignancies, and medications. Those medications include
anticonvulsants and antibiotics.
• Cases commonly appear in the fall and spring.

5. 2
• Which one of the following statements is true about erythema
multiforme?
• (A) Steroids shorten the course of the disease
• (B) Bullous skin lesions cause denudement of the skin
• (C) Prophylactic antibiotics reduce the risk of infection
• (D) Mucosal lesions can be maculopapular, urticarial, or target shaped
• (E) Patients must be instructed to have a follow-up visit in 1 week

6. • The answer is B.
• Bullous skin lesions can be found in erythema multiforme.
• They cause denudement of the skin. Lesions are typically maculopapular,
urticarial, target shaped, vesicular, or bullous.
• Mucosal lesions are typically vesiculobullous.
• Systemic steroids are controversial. They may provide symptomatic relief.
However, they do not shorten the course of the disease.
• Antibiotic prophylaxis is not proven to be effective and can result in
colonization by drug-resistant bacteria.
• Follow-up in less than 1 week is essential to monitor for the potential
development of SJS. Topical steroids are used for symptomatic relief.

10. 3
• All of the following can be found in association with allergic contact
(toxicodendron) dermatitis EXCEPT
• (A) urticaria
• (B) vesicles and bullae
• (C) sparing of the palmar aspects and web spaces of the hands
• (D) a linear pattern of erythema and papules
• (E) a 3- to 5-day course for dermatologic manifestation

11. • The answer is E.
• A 3- to 5-day course for the dermatologic manifestation is not typical
of the disease. Mild cases typically last 7 to 10 days, whereas severe
ones can require more than 3 weeks of therapy.
• Urticarial eruptions result from systemic absorption.
• Common manifestations include linear patterns, erythema, papules,
vesicles, and bullae.
• Target lesions of erythema multiforme have been reported.
• Lesions on the hands typically are dorsal and spare the palmar aspect
and web spaces

15. 4
• All of the following are true about erysipelas EXCEPT
• (A) facial and scalp manifestations occur in infants and the elderly
• (B) it progresses to skin desquamation
• (C) bacteremia common in the lower extremity manifestations
• (D) fever
• (E) a sharp well-demarcated edge

16. • The answer is C.
• Erysipelas is a distinct Streptococcus A cellulitis.
• High fever is common.
• Bacteremia is also typically common except in lower extremity
manifestations.
• Facial and scalp manifestations are predominately in infants and in
the elderly.
• It progresses to skin desquamation during convalescence. A sharp
well-demarcated advancing edge is distinctive.

19. 5
• All of the following are indicated in the treatment of scabies
infestations in pregnancy and young children EXCEPT
• (A) premethrin (Elemite)
• (B) lindane
• (C) calamine lotion
• (D) 5 percent sulfur solution
• (E) two or three applications 24 or 12 h apart, respectively

20. • The answer is B.
• Lindane and cromatiton are two scabicides with potential toxicity that
should be avoided in pregnancy and young children.
• Premethrin (Elemite) and a 5 percent sulfur solution are used typically
in two applications 24 h apart.
• A third application 12 h later can be also used.

23. 6
• Clinical features of a disseminated gonococcal infection include all of
the following EXCEPT
• (A) an association with menses
• (B) an association with pregnancy
• (C) fever and multiple papular, vesicular or pustular lesions
• (D) arthralgias
• (E) treatment with oral ciprofloxacin is replacing the traditional use of
intravenous ceftriaxone

24. • The answer is E.
• Disseminated gonococcal infections should be treated with
intravenous ceftriaxone or ciprofloxacin for 7 days. Oral outpatient
management with ciprofloxacin is not an accepted standard of care
for complicated cases of gonococcal infections.
• An association with menses, late pregnancy, and the immediate
postpartum period is common.
• Fever, arthralgias, and multiple (10 to 20) papular, vesicular, or
pustular lesions are classic features of the disease

26. Thank you