Emergency Medicine

SKIN DISORDERS

114 General Medical Emergencies

(iv) Endocrine:

(a) myxoedema

(b) thyrotoxicosis.

(v) Carcinoma:

(a) lung

(b) stomach.

(vi) Drugs.

3 Take a general medical history, and ask in particular about medications.

MANAGEMENT

1 Refer patients unable to sleep with intractable pruritus to the dermatology

team or medical team.

2 Otherwise give symptomatic treatment including:

(i) Antipruritic drug orally:

(a) promethazine 10 mg t.d.s. with a warning about drowsiness.

(ii) Scabies:

(a) scabies is suggested by itch worse at night that does not

involve the head, a close partner affected, and finding

burrows (often excoriated) in interdigital webs, around the

genitalia, or on the nipples

(b) treat the patient and close contacts with 5% permethrin

aqueous lotion over the whole body including the face and

hair, washed off after 8–24 h; all clothes should also be washed

(c) explain to the patient that although itching may persist, it is

no longer contagious

(d) advise the patient to attend a genitourinary medicine clinic

to exclude an associated sexually transmitted disease if the

scabies followed casual sex.

(iii) Urticaria, see page 110.

(iv) Cease any recent drug therapy considered causal, including non-

prescription drugs.

4 Return the patient to the care of their GP.

Purpuric conditions

DIAGNOSIS

1 Petechiae and purpura are non-blanching, cutaneous areas of bleeding that

may be non-palpable or palpable.

2 Causes of non-palpable purpura include:

(i) Thrombocytopenia, with splenomegaly:

(a) normal marrow:

• liver disease with portal hypertension


• myeloproliferative disorders