Abstract
Acute dermatological problems are seen regularly by physicians. This review aims to provide a framework for the diagnosis and management of urgent dermatological conditions. Cutaneous drug reactions are commonly seen and the different clinical presentations are discussed including the less common but important drug reactions Stevens- Johnson syndrome and toxic epidermal necrolysis. Erythrodermic patients also require prompt evaluation and management. Current guidelines for the management of urticaria and the common acquired autoimmune bullous disorders will be discussed. Patients with complications of eczema and psoriasis frequently require urgent in-patient management and patients with cellulitis and leg ulcers are also seen regularly on acute medical receiving units often requiring both medical and dermatological input.
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References
- Kirsner RS, Yang DG, Kerdel FA. Dermatologic disease accounts for a large number of hospital admissions annually. J.Am.Acad.Dermatol. 1999 Dec; 41(6): 970-973.
- Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Safety 2007; 30(11): 1011-1030.
- Campos-Fernandez Mdel M, Ponce-De-Leon-Rosales S, Archer-Dubon C, et al. Incidence and risk factors for cutaneous adverse drug reactions in an intensive care unit. Revista de Investigacion Clinica 2005 Nov-Dec; 57(6): 770-774.
- Burns T, Breathnach S, Cox N, et al. Rook’s Textbook of Dermatology. seventh edition ed. UK: Blackwell Publishing; 2004.
- Tan EK, Grattan CE. Drug-induced urticaria. Expert Opinion on Drug Safety 2004 Sep; 3(5): 471-484.
- Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int.J.Dermatol. 1998 Nov; 37(11): 833-838.
- Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br.J.Dermatol. 2007 Nov; 157(5): 989-996.
- Tas S, Simonart T. Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update. Dermatology 2003; 206(4): 353-356.
- Roujeau JC. Stevens-Johnson syndrome and toxic epidermal necrolysis are severity variants of the same disease which differs from erythema multiforme. J.Dermatol. 1997 Nov; 24(11): 726-729.
- Roujeau JC. The spectrum of Stevens-Johnson syndrome and toxic epidermal necrolysis: a clinical classification. J.Invest.Dermatol. 1994 Jun; 102(6): 28S-30S.
- Schulz JT, Sheridan RL, Ryan CM, et al. A 10-year experience with toxic epidermal necrolysis. J.Burn Care Rehabil. 2000 May-Jun; 21(3): 199-204.
- Bastuji-Garin S, Fouchard N, Bertocchi M, et al. A severity-of-illness score for toxic epidermal necrolysis. J.Invest.Dermatol. 2000 Aug; 115(2): 149- 153.
- Garcia-Doval I, LeCleach L, Bocquet H, et al. Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death? [see comment]. Arch.Dermatol. 2000 Mar; 136(3): 323-327.
- Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J.Am.Acad.Dermatol. 2007 Feb; 56(2): 181-200.
- Chia FL & Leong KP. Severe cutaneous adverse reactions to drugs. Current Opinion in Allergy & Clinical Immunology 2007; 7: 304-9
- Rothe MJ, Bernstein ML, Grant-Kels JM. Life-threatening erythroderma: diagnosing and treating the “red man”. Clin.Dermatol. 2005 Mar-Apr; 23(2): 206-217.
- Brown SG. Clinical features and severity grading of anaphylaxis. Journal of Allergy & Clinical Immunology 2004 Aug; 114(2): 371-376.
- Grattan CE, Humphreys F, British Association of Dermatologists Therapy Guidelines and Audit, Subcommittee. Guidelines for evaluation and management of urticaria in adults and children. Br.J.Dermatol. 2007 Dec; 157(6): 1116-1123.
- Sachse MM, Khachemoune A, Guldbakke KK, et al. Hereditary angioedema. Journal of Drugs in Dermatology: JDD 2006 Oct; 5(9): 848- 852.
- Pekdemir M, Ersel M, Aksay E, et al. Effective treatment of hereditary angioedema with fresh frozen plasma in an emergency department. J.Emerg.Med. 2007 Aug; 33(2): 137-139.
- Wojnarowska F, Kirtschig G, Highet AS, et al, British Association of D. Guidelines for the management of bullous pemphigoid. Br.J.Dermatol. 2002 Aug; 147(2): 214-221.
- Harman KE, Albert S, Black MM, British Association of D. Guidelines for the management of pemphigus vulgaris. Br.J.Dermatol. 2003 Nov; 149(5): 926-937.
- Peng WM, Jenneck C, Bussmann C, et al. Risk factors of atopic dermatitis patients for eczema herpeticum. J.Invest.Dermatol. 2007 May; 127(5): 1261-1263.
- Mengesha YM, Bennett ML. Pustular skin disorders: diagnosis and treatment. American Journal of Clinical Dermatology 2002; 3(6): 389-400.
- Lotti T, Ghersetich I, Comacchi C, et al. Cutaneous small-vessel vasculitis. J.Am.Acad.Dermatol. 1998 quiz 688-90; Nov; 39(5 Pt 1): 667-687.
- Carlson JA, Chen KR. Cutaneous vasculitis update: small vessel neutrophilic vasculitis syndromes. Am.J.Dermatopathol. 2006 Dec; 28(6): 486-506.
- Carlson JA, Cavaliere LF, Grant-Kels JM. Cutaneous vasculitis: diagnosis and management. Clin.Dermatol. 2006 Sep-Oct; 24(5): 414-429.
- Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ 1999 Jun 12; 318(7198): 1591- 1594.
- Cox NH. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br.J.Dermatol. 2006 Nov; 155(5): 947-950.
- Gabillot-Carre M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr.Opin.Infect.Dis. 2007 Apr; 20(2): 118-123.
- Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria.[see comment]. JAMA 2004 Dec 8; 292(22): 2771-2776.
