Dermatologic Emergencies
Nicholas Satterfield MD
Objectives
1. Define dermatologic terminology
2. Differentiate between erythema multiforme, Steven-Johnson syndrome and toxic epidermal
necrolysis.
3. Differentiate between immune thrombocytopenic purpura and thrombotic thrombocytopenic
purpura
4. Understand basic management of some dermatologic disease
Dermatologic Terminology
 Macule: color change of the epidermis that is less than 0.5-2cm
 Patch: color change of the epidermis that is greater than 0.5-2cm
 Papule: elevated lesion that is less than 0.5-2 cm
 Plaque: elevated lesion that is greater than 0.5-2 cm
 Nodule: elevated skin lesion with significant depth to involve more than the epidermis
 Vesicle: fluid filled superficial lesion less than 0.5-2 cm
 Bullae: fluid filled superficial lesion greater than 0.5 to 2 cm
 Pustule: vesicle with purulent fluid
 Petechiae: violacious non blanchable lesion less than 0.5-2 cm from extravasated blood
 Purpura: violacious, non blanchable lesion greater than 0.5-2 cm from extravasated blood
 Erosion: loss of the epidermis
 Excoriation: loss of epidermis due to itching
 Ulceration: loss of epidermis and dermis
 Crusting: collection of dried serum and cellular debris
 Lichenification: epidermal thickening
 Atrophy: thinning of epidermis and dermis
 Scaling: shedding excess dead epidermal cells by keratinization
Differentiate between erythema multiforme (EM) major, EM minor, Steven-Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN)
Epidermal
Detachment
Mucosal
Involvement
Most Common
Etiology
Degree of
Epidermal
Detachment
EM Minor
No
EM Major
NO
SJS
Yes
TEN
Yes
No
Yes
Yes
Yes
Infectious
Infectious
Drug Reaction
Drug Reaction
0 % BSA
0% BSA
<10% BSA
>30% BSA
Differentiate between immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic
purpura (TTP)
Pathogenesis
Clinical condition
Red cells
PT/PTT
Fibrinogen
D-dimmer
Therapy
ITP
Antiplatelet Antibodies
Mild Illness
Normal
Normal
Normal
Normal
Steroids, IVIG
TTP
Reduced ADAMTS13 activity
Severe Illness
Schistocytes
Normal to Mild Increase
Normal
Mild Increase
Plasma Exchange, Steroids
Management of Some Dermatologic Disease
 Erythema Multiforme
o Supportive care: NSAIDS, antihistamine
o Topical steroids
o Consider oral steroids if severe
o Dermatology referral
o Urgent ophthalmology if ocular symptoms (consider ophthalmic steroids and antibiotics)
 Steven-Johns Syndrome and Toxic Epidermal Necrolysis
o Admit
o Transfer to burn unit of SCORTEN greater than or equal to 2
o Fluid and electrolyte management
o Stop suspected medication
o Dermatology consult
o Consider steroids
 Pemphigus Vulgaris
o Steroids
o Admit if lesions appear infected or patient looks toxic
o If no admission outpatient dermatology follow up
 Meningococcemia
o Treat with ceftriaxone 2 g Q12
o For severe penicillin allergies: Chloramphenicol 4g per day
o Sepsis care
o Contact prophylaxis
 Cipro 500 mg once
 Rifampin 600 mg BID for two days
 In pregnancy: single dose IM ceftriaxone 250 mg
 ITP
o Platelets for severe bleed
o Steroids for patients for serious bleeds, minor bleeds or new diagnosis with platelets
less than 30,000
o IVIG for serious bleeds or significant bleeds with platelets less than 30,000
o Pediatrics: Only treat with steroids if significant bleeding
 TTP
o Plasma exchange
o Steroids