Vesiculobullous rashes
Immunologically mediated syndrome.
May be idiopathic, but usually pre-cipitated by infection (e.g. mycoplasma,
herpes simplex, other viruses) or drugs (e.g. sulfonamides, penicillin).
See b Plate 4.
•
Crops
of characteristic symmetric ‘target’ lesions develop with pallid or purple
centre surrounded by erythematous ring.
•
May
also be haemorrhagic, red macules or large bullae.
•
Lesions
last 2–3wks and affect hands, feet, elbows, knees.
•
Typically,
mucous membrane ulcers occur (buccal, eye, genitalia).
If precipitating infection recurs
treat early as tends to cause rash again, e.g.
topical aciclovir for recurrent
HSV.
•
Fluid
maintenance.
•
Analgesic
mouthwashes.
•
Lip
emollient ointment.
•
Oral
antihistamines.
Complete recovery, but may recur.
Severe, and overlapping condition
with erythema multiforme except usu-ally drug induced with viral infection
rarely implicated.
See b Plate 5.
•
Widespread
blisters/bullae over erythematous, purple macular, or haemorrhagic skin.
•
Mucous
membranes often affected with haemorrhagic crusting.
•
Rubbing
may cause skin separation at epidermodermal junction (= positive Nikolsky
sign).
•
Also
possible fever, arthralgia, myalgia, prostration, renal failure, pneumonitis,
conjunctivitis, corneal ulceration, blindness.
•
Supportive,
as for severe burns (e.g. hydration, airway protection).
•
Identify
causative antigen and remove/treat.
•
Frequent
emollient ointment.
•
Specialist
eye care.
•
Systemic
corticosteroids or immunoglobulin used in first 2–3 days may be helpful if
life-threatening.
Can be life-threatening. Recovery
usually occurs in 3–4wks.
Exotoxin-mediated epidermolysis s to Staphylococcus aureus infection (which may be trivial). Occurs in
children <5yrs.
•
Extensive
tender erythema with flaccid superficial blisters/bullae (‘scalded
appearance’).
•
Erosions
and +ve Nikolsky sign.
•
Crusting
around eyes and mouth, fever.
•
Supportive
treatment and analgesia.
•
IV
anti-staphylococcal antibiotics.
•
Gentle
skin care, emollient ointments.
Rapid recovery without scarring.
Highly contagious Staphylococcus aureus or B-haemolytic streptococcal
superficial skin infection. May be p or
complicate other skin disease (e.g. HSV infection, eczema, scabies). Risk
factors include overcrowding and poor hygiene.
•
Superficial,
rapidly spreading initially clear blisters that rapidly develop into
straw-coloured ‘dirty’ looking lesions with yellow crusting.
•
Often
starts around nose and face; neonates may develop bullous impetigo.
•
Risk
of staphylococcal scalded skin syndrome or acute glomerulonephritis
(streptococcal).
Skin swabs for bacterial culture
and sensitivity.
Rapidly resolves if:
•
bathe
crusts off using antiseptics (contain infectious bacteria);
•
antibiotics
(e.g. topical mupirocin 2% ointment or oral flucloxacillin);
•
treat
any predisposing condition.
Caused by friction, burns, or
insect bites. Sterile aspiration of blister within 12hr after appearance, and
pressure dressing may be curative.
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