Emergency Medicine

SKIN DISORDERS

116 General Medical Emergencies

MANAGEMENT

1 Management is of t he underly ing cause.

2 This is urgent for suspected meningococcaemia with ceftriaxone 2 g i.v. and

for Rocky Mountain spotted fever with doxycycline 100 mg orally b.d.

Exanthematous diseases

DIAGNOSIS

1 Exanthems are generalized erythematous, often blanching, maculopapular

eruptions secondary to viral or bacterial infection.

(i) Some have ‘classic’ clinical presentations such as chickenpox,

fifth disease, glandular fever, measles, rubella and scarlet fever

(see Table 2.9).

(ii) Others are non-specific rashes, secondary to enteroviruses or

respiratory viruses.

2 Ask about recent known contacts, particularly at childcare or in school, as

well as any constitutional symptoms such as fever and malaise.

3 Most are diagnosed on clinical features, but serology for antibody titres may

aid confirmation, particularly when there is concern following contact in a

pregnant person.

MANAGEMENT

1 Give symptomatic treatment, or phenoxymethylpenicillin 250–500 mg

orally q.d.s. for 10 days in the case of streptococcal scarlet fever.

2 Isolate the patient at home until non-infectious.

(i) Rarely admission is indicated in the immunosuppressed, or

patients with severe systemic features.

3 Discuss pregnant contacts of a rubella or fifth disease patient with an infec-

tious disease specialist or obstetrician.

MALIGNANT MELANOMA

The incidence of malignant melanoma has doubled in many countries over the

past decade.

DIAGNOSIS AND MANAGEMENT

1 Look for the following suspicious signs when a malignant melanoma is possible:

(i) Major signs:

(a) change in size, e.g. an increase in size of a new or pre-existing

cutaneous lesion

(b) change in shape, especially an irregular outline

(c) change in colour, including multiple (variegated).