Lecture Notes
Deadly Dermatology

Dr Ian McCrossin showed us some very scary images of severe dermatological disorders at the October medical update.

These conditions included:

  • Drug Eruption with Eosinophilia and Systemic Symptoms (DRESS) – is a drug reaction that occurs a long time after starting the drug. Stopping the drug, looking for systemic involvement and giving steroids is important. Common drugs include allopurinol, antiepileptics and antibiotics (sulfonamides).
  • Toxic Epidermal Necrolysis (TEN) is a severe skin condition where whole sheets of skin fall off. There is often a prodrome of fever / malaise, then mucosal ulceration, bullae and desquamation. This is best treated in burns unit because good nursing care is critical.
  • Stevens Johnson Syndrome (SJS) – this is on the same spectrum of illness as TEN, but it is usually called SJS if <10% of the body surface area is affected, TEN if >30% affected, or an overlap between the two if 10-30%. Both are usually drug induced. As above, a prodrome of fevere, malaise and arthraglgia is followed by a sudden macular morbiliform rash, sheeting off of the epidermis and mucus membrane lesions that parallel the rash.
  • Staphylococcal Scalded Skin Syndrome – affects children and needs antibiotics, not steroids.
  • Necrotising Fasciitis – pain, erythema and oedema with a high fever and toxicity, bullae and necrosis of the skin. The necrotic areas become anaesthetised (which can be a useful sign for diagnosis – check if the suspected area is completely numb). Debridement is needed urgently.
  • Sweet Syndrome is a mimic of necrotising fasciitis and does NOT need debridement. It can be triggered by things including Strep or chemotherapy. If there are multiple areas, it is unlikely to be necrotising fasciitis and more likely Sweet Syndrome.
  • Acute Meningococcaemia – nonblanching stellate shaped lesions with central clearing are classic. Complications include purpura fulminans.
  • Rickettsia australis does occur on the South Coast. It responds to doxycycline and rehydration.
  • Varicella – can be severe in adults, and is commonly missed / misdiagnosed. Blisters of varying ages usually start on the head and spread downward from there.
  • Acute retrovirus syndrome – not all rashes on the palms and soles are syphilis.

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