CURRENT Essentials of Critical Care.pdf

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Chapter 18 Dermatology 267■■■Miliaria (Heat Rash)Essentials of Diagnosis• Common disorder characterized by retention of sweat in bedriddenpatients with fever and increased sweating• Miliaria crystallina: small, superficial sweat-filled vesicles thatrupture easily, without surrounding inflammation (“dew-drops”on skin)• Miliaria rubra (prickly heat): discrete, pruritic, erythematouspapules and vesiculopustules on back, chest, antecubital andpopliteal fossae• Burning, itching, superficial small vesicles, papules or pustuleson covered areas of the skinDifferential Diagnosis• Folliculitis (miliaria rubra)Treatment• Keep patient cool and dry• Symptomatic treatment for pruritus■ PearlObstruction of eccrine sweat glands leads to formation of miliaria.ReferenceFeng E et al: Miliaria. Cutis 1995;55:213. [PMID: 7796612]
268 Current Essentials of Critical CareMorbilliform, Urticarial, & Bullous Drug Reactions■ Essentials of Diagnosis• Onset of rash 5–10 days after exposure to new drug, or 1–2 daysfollowing re-exposure to drug to which a patient has been sensitized;occurs in 25–30% of hospitalized patients• Usually symmetric, widespread, with pruritus and low gradefever; resolution of rash when drug discontinued supports diagnosis• Morbilliform eruptions most common form of drug-inducedrash; usually begins on trunk or dependent areas• Urticaria characterized by pink, edematous, pruritic wheals ofvarying size and shape, usually lasting less than 24 hours• Angioedema represents urticarial involvement of deep dermaland subcutaneous tissues, sometimes involving mucous membranes• Bullous drug eruptions include fixed-drug eruptions, erythemamultiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis,vasculitis, and anticoagulant necrosis■ Differential Diagnosis• Morbilliform eruption: bacterial or rickettsial infection, or collagen-vasculardisease• Non–drug-associated urticarial eruptions: food allergies, insectbites or stings, parasitic infections, and vasculitis or serum-sickness• Bullous drug eruptions: primary bullous dermatoses (bullouspemphigoid, porphyria cutanea tarda)■ Treatment• Identify and discontinue likely causative agents; substitutechemically unrelated alternatives• Morbilliform eruptions: supportive measures, symptomatictreatment (oral antihistamine, topical anti-pruritic agent)• Urticarial eruptions: if severe, aggressive supportive measuresto support blood pressure; epinephrine, fluids, antihistamines,sometimes corticosteroids• Blistering eruptions: decompress large bullae; topical compressesto remove exudates or crusts■ PearlDrug eruptions are most commonly associated with antibiotics, anticonvulsants,and blood products.ReferenceNigen S et al: Drug eruptions: approaching the diagnosis of drug-induced skindiseases. J Drugs Dermatol 2003;2:278. [PMID: 12848112]
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a LANGE medical bookCURRENTESSENTIA
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ContentsPreface....................
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ContentsvLife-Threatening Hemoptysi
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Page 307 and 308: Antineutrophil cytoplasmic antibodi
Page 309 and 310: Confusion, 227, 234, 235, 239, 240,
Page 311 and 312: Endoscopy, 170, 174gastric varices
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Page 315 and 316: Lidocaine, 8, 130, 230, 231, 243Lig
Page 317 and 318: Oxygen therapy, 87, 93for hypervole
Page 319 and 320: Respiratory failure, 56, 83, 86, 10
Page 321: Trismus (lockjaw), 156Trousseau sig
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