By Rachael Morris-Jones
A 23-year-old African Caribbean lady offers within the emergency division with an acute onset facial rash. in the course of preliminary overview she complains of a week heritage of normal malaise, fatigue, fever, and weight-loss. you've been assigned her examination...
100 instances in Dermatology offers a hundred situations with a dermatological manifestation as a rule obvious via clinical scholars and junior medical professionals. A succinct precis of the patient's historical past, exam and preliminary investigations, together with complete color photos exhibiting presentation, is by means of questions about the analysis and administration of every case. the reply contains a special dialogue on each one subject, with additional representation the place acceptable, supplying a necessary revision relief in addition to a pragmatic advisor for college students and junior doctors.
Making medical judgements and selecting the easiest plan of action is without doubt one of the such a lot demanding and hard components of teaching to turn into a physician. those instances will train scholars and junior medical professionals to acknowledge vital dermatological indicators and symptoms and, the place acceptable, their courting to different health conditions, and to improve their diagnostic and administration skills.
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Additional info for 100 Cases in Dermatology
1). More than 30 per cent of her skin surface is affected, Nikolsky’s sign is positive. 4 ϫ 109/L C-reactive protein 147 mg/L Ͻ5 mg/L HIV viral load 79 869 copies/mL CD4 lymphocyte count 229 A cardiotocography (CTG) examination was normal. Urea, bicarbonate and glucose tests were all normal. A skin biospy was taken. Questions • What is the most likely cause of this patient’s sudden-onset skin eruption? • What is the prognosis for the patient and her baby? • How would you manage them? 49 ANSWER 23 This presentation with widespread skin loss is typical of drug-induced toxic epidermal necrolysis (TEN).
Patients usually require systemic therapy; historically ciclosporin has been given for its fast mode of action. However, some dermatologists are now treating these very sick patients with first-line systemic anti-tumour necrosis factor alpha preparations such as infliximab. KEY POINTS • Erythroderma is when almost the entire skin (Ͼ 90%) becomes red. • It is a serious and at times life-threatening dermatological emergency. • Management is supportive in addition to treatment of the underlying cause.
There are no blisters or pustules, the palms and soles are spared. Toxic erythema usually starts within two weeks of taking a new medication. Sudden-onset widespread rashes are usually ‘reactive’ with the two most common underlying causes being ‘drugs or bugs’. The key to identifying the culprit drug is the taking of a detailed history of the patient’s medications and the time course over which each was started in relation to the onset of the rash. In this case the drug responsible is penicillin.