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Functions of the skin
The important thing to consider when a patient has their skin peeling off, and everyone is screaming, is "What is the skin for?".
It provides a barrier. It keeps moisture in, and keeps bad stuff out. If the barrier is failing, replace it with a load of vaseline, whilst you work out what on earth to do.
Disemminated Herpes Simplex
When the skin barrier is broken, viruses get through easily. This is why people with bad eczema have warts for longer. And so those with skin breaks are more of a risk
Disemminated Herpes Simplex gets treated with high dose aciclovir and supportive care. It is widespread and painful.
Urticaria, Angio-oedema & Anaphylaxis
- Urticaria: Hives, Common, Transient swellings.
- Angioedema: Large area of oedema, involves dermis and subcutis, and can affect the face. Often seen in anaphylaxis. You need to send these guys to Hospital straight away, as their airway can be obstructed.
Acute Contact Dermatitis
Chuck on some Betnovate ointment quickly, rather than oral prednisolone - it will work faster topically than systemically.
Apply one fingertip worth per each hand's worth. So your face can be covered by two hands, so use two fingertips worth.
Cover them in vaseline. Have a low threshold for sending the patient in. Is the patient unwell? Have they got pustules forming?
Such as Bullous Pemphigoid - More commonly seen in older people. Cover them with vaseline and Betnovate ointment.
Describe it - how extensive is it, is it affecting their mouth or airways?
- Commonest is an urticaria from penicillin reaction. Doesn't need treating.
- Erythema multiforme - causes target lesions, that you can see on the palms and soles. If not causing problems to mucous membranes, doesn't need treating.
- Toxic epidermal necrolysis - needs to be admitted. The skin basically falls off, and the patient is really unwell. They need to be treated with similar methods to burns patients.
- Vasculitic rashes - should be reviewed, just to rule out further complications.