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!