Dermatological Emergencies

Key concepts

  • You have to be able to describe the lesion(s) to diagnosis and manage it
  • Key steps: accurate history, physical examination, including lesions and distribution, and appropriate diagnostic tests.
  • Incision and drainage may be adequate therapy for simple abscesses**.
  • Tinea capitis requires 4 to 8 weeks of systemic antifungal treatment.
  • Onychomycosis requires long-term systemic treatment.
  • Newer nonsedating antihistamines are a useful alternative to older sedating ones to control pruritus and histamine-mediated rashes while allowing the patient to remain active.
  • Scabies infestations should be diagnosed clinically and treated expeditiously even without definitive proof of the infestation.
  • Medication reactions are common and may results from any medication, typically within 4 to 21 days after taking the medication.
  • Rashes that are associated with mucosal lesions, blisters, or desquamating skin are often caused by significant soft tissue infections, drug eruptions, or immune disorders.
  • Patients with Stevens-Johnson syndrome (<10% TBSA) and toxic epidermal necrolysis require inpatient treatment, preferably in a burn unit.
  • Cutaneous signs of systemic disease may include pruritus, urticaria, erythema multiforme, erythema nodosum, pyoderma gangrenosum, and others.
  • Physicians should be familiar with one or two topical steroid preparations of low, medium, and high potency and their appropriate therapeutic use.
    • Hydrocortisone 0.1% lotion – low/mid
    • Hydrocortisone valerate 0.2% ointment – mid
    • Betamethasone dipropionate 0.05% cream – high (more potent than beta.val)
  • Life-threatening conditions at risk for dehydration and infection require inpatient treatment – the rest should be managed as outpatients!

 

EMKF

The Emergency Medicine Kenya (EMK) Foundation is a not-for-profit organization registered in Kenya in 2015 that aims to ensure timely, accessible and quality lifesaving emergency care in Kenya.