Emergency Medicine

SKIN DISORDERS

General Medical Emergencies 113

(i) This should include any patient with SJS, TEN, SSSS, pemphigus

and pemphigoid, who may die from intercurrent infection and

multi-organ failure.

2 Otherwise give symptomatic treatment including:
(i) Antihistamine orally such as promethazine 10 mg t.d.s. if there is
associated pruritus, with a warning about drowsiness.
(ii) Antibiotics orally such as flucloxacillin 500 mg q.d.s. or
cephalexin 500 mg q.d.s. for secondary staphylococcal infection
in herpes zoster, impetigo, insect bites and eczema. Give
clindamycin 450 mg t.d.s. for patients with severe penicillin
allergy.
(iii) Parasiticidal preparation for scabies (see p. 114).
(iv) Antiviral agent orally such as aciclovir 200 mg five times a day
for 5 days for severe herpes simplex, or 800 mg five times a day or
famciclovir 250 mg t.d.s. for 7 days for severe herpes zoster.
(v) Topical steroid antiseptic such as 1% hydrocortisone with 1%
clioquinol cream t.d.s. for papular urticaria and bullous eczema.

3 Return the patient to the care of their GP.

Pruritus (itching conditions)

DIAGNOSIS

1 Causes of pruritus with skin disease:
(i) Scabies, pediculosis, insect bites, parasites (roundworm).
(ii) Eczema.
(iii) Contact dermatitis.
(iv) Urticaria.
(v) Lichen planus (pruritic, planar, purple, polygonal papules with
chronic oral mucous membrane involvement).
(vi) Pityriasis rosea (upper respiratory infection preceding ‘herald’
patch, followed after 7–14 days by a pink or red, flaky, oval-
shaped rash).
(vii) Drugs, which may cause any of the conditions (ii)–(vi) above.
(viii) Dermatitis herpetiformis (chronic itchy, papulovesicular
eruptions, usually distributed symmetrically on extensor surfaces,
associated with gluten sensitivity).

2 Causes of pruritus without skin disease:
(i) Hepatobiliary – jaundice, including primary biliary cirrhosis.
(ii) Chronic renal failure.
(iii) Haematological:
(a) lymphoma
(b) polycythaemia rubra vera.