This comprehensive session will encompass a range of dermatological conditions, beginning with Stevens Johnson syndrome and toxic epidermal necrolysis. These are characterized by severe mucosal ulceration and are typically triggered by medications. The medication involved determines the name assigned to the condition and the body surface area affected. The session will with other skin conditions like erythroderma and their etiologies. Emphasis will be laid on how to identify and manage these conditions, with insights provided into potential complications, including secondary infection, multi-organ failure, and ocular involvement. Management processes will be extensively discussed, including removing causative agents, procuring urgent help from dermatologists, and providing supportive care in ICUs. Medical professionals interested in learning or refining their knowledge in dermatological conditions should attend this session.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
So this is just an overview of everything that we're going to cover. So we'll start with S Js and TM. Um Auripro derma, staphylococcal scalded skin skin syndrome, necrotizing fasciitis, eczema, hepaticum vasculitis, and then acute urticaria and angioedema. So, firstly, we'll start with Stevens Johnson syndrome or toxic epidermal necrolysis. So, these are a spectrum of disease. Um and it's characterized by severe mucosal ulceration and blistering of the skin and you can have different body surface area, um detachment. So the name that you use is determined by the percentage of body surface area affected. So it's Stevens Johnson syndrome. If you've got less than 10% involvement, it's Steven Steven Johnson syndrome or and toxic epidermal neck crisis overlap if you've got 10 to 3010 to 30% body surface area and then it's toxic epidermal necrolysis if you've got more than 30% involvement of the body surface area. So, in terms of etiology, um it's a new mediated um hypersensitivity pri triggered by medications. So, some of the key medications are sulfonamides. So things like cotrimoxazole, otherwise known as se and also drugs like sulfaSALAzine, which is one of the disease, modifying anti rheumatic drugs, otherwise known as da used in rheumatoid arthritis. Um, but it's also used in inflammatory bowel disease. You've also got anti anticonvulsants. Um One of the most implicated includes carBAMazepine and then you've got nsaids and allopurinol used in gout. Um And then there's infections that can cause ST S or on or 10 such as mycoplasma and cytomegalovirus. So this is just an image showing the spectrum of disease. So you've got the S Js with less than 10% you've got the S AST N overlap with 10 to 30%. And then you've got TN with more than 30% involvement, sorry, it's taking a while to sweat. So in terms of the clinical features, um it will start with a prodromal illness and you'll get things like fever, feeling tired, you'll have a sore throat and then you get these painful arithmetic macules which are these flat localized lesions, you then get string. Um And then after that, you get widespread epidermal detachment and then you can get mucosal involvement. So all involvement, involvement of the eyes, involvement of the genital. And one of the key things to remember is that you get Nikolsky sign positive. So this is separation of the epidermis from the dermis. You get when pressure is applied to the skin. So these are just some images depicting SS and TN. So in the top left, you can see those flat unlocalized lesions and macules and then in the top right, you can see um Nikolski dying. So the pressure has been applied and then you've got the epidermis operating from the dimness. And then you can see some oral involvement in the bottom left corner, um in the middle, you can see some ocular involvement and then um to the right hand side, you can also see all involvement and then you can see some separation of the epidermis from the dim. So, complications that you can get from SA N SAS or TN include secondary infection. You can also get multi organ failure, leading to respiratory failure, acute kidney injury and liver dysfunction. So, the reasoning behind this is that the epidermal detachment kind of acts like severe burns. Um and then this leads to excessive fluid loss and excessive protein loss. And then one of the electrolyte imbalances mentioned in the se in the point after this um would be so you essentially get fluid loss, protein loss and then it will lead to hypovolemia and then you can get a hypovolemic hyponatremia and then you can get things like shock AKI i multiorgan dysfunction. Um And then depending on the stage of disease, you can also get hyperkalemia, hyperkalemia. Um you can also get ocular involvement, so you can get conjunctivitis, corneal ulceration. Um and this can lead to blindness and then you can get gastrointestinal involvement. So you can get um mucosal slowing and esophageal strictures. So, in terms of management, the first thing that you want to do is withdraw the causative agent, which is most likely one of the drugs that have been mentioned. Um You'd want to get urgent involvement of the on call dermatologist and you'd also want to urgently refer to ophthalmology. If the eyes were affected, you then provide supportive care in ICU or burn unit. So, fluid resuscitation, nutritional support. So you might um use um parental nutrition. Um you want to manage their pain by giving them some analgesia. You want to focus on wound care, um temperature control and then in severe cases, you might consider systemic therapy. Um One of the things that you'd also want to do is assess the total body involvement. So you can determine where you are on the spectrum. And something else that you can do is calculate the score 10 for prognosis. So score 10 stands for severity of illness, score for toxic epidermal necrolysis and it takes into account different parameters. So age cancer, um percentage of skin detachment, pulse rate, bicarb level in the blood urea glycemia, and then you get a total score and then based on what the score is, um it estimates your risk of death in the acute phase. So the next emergency that we're going to cover is erythroderma. So this is generalized erythema affecting more than 90% of the body surface area and it's associated with desquamation, which is the shedding of the epidermis. And it's otherwise known as expos to dermatitis. Um So, in terms of etiology, um typically, it can happen with preexisting dermatological conditions. So things like eczema psoriasis, um seborrheic dermatitis, um drugs. So, sulfonamides again, allopurinol anticonvulsants and penicillins um can be associated with malignancy. So, cutaneous T cell lymphoma um as a part of Cesare syndrome. So, this is a triad of aroma lymphadenopathy and circulating malignant T cells which are called cesare cells in the blood. Um It can also be caused by systemic disease. So, HIV graft versus host disease and it can be idiopathic. So, in terms of the clinical features, so you get systemic symptoms once again. So fever chills, malaise um lymphadenopathy, which may indicate malignancy. You can get edema and you can also get weight loss. You'll also get, you'll then get a patchy erythema, which spreads to be universal within 12 to 48 hours. And then you get scaling which appears 2 to 6 days later and the skin will be warm to touch and it will be thickened and you'll have variable degrees of lichenification. You can also get Kroto um so called palmo Planta Crader where you get thickened skins on the palm and palms and soles. And then you can get on a callis, which is the lifting of the nail plate from the distal nail bed. So here's some images depicting erythroderma. So you've got that a arithmetic skin and then you can see some scaling in the middle pit
