By Daniel Creamer
Makes a speciality of dermatoses with a surprising onset, fast development or with neighborhood or systemic morbidity. This name covers quite a few universal inflammatory and infective dermatoses, rarer stipulations: rashes, tumours, connective tissue sickness, travelllers' dermatoses and drug eruptions.
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Additional resources for Acute Adult Dermatology: Diagnosis and Management: A Colour Handbook
Plaque psoriasis (p. 28, confluent scaly plaques, nail changes). 32, widespread erythema with myriads of tiny pustules) (64). • Atopic dermatitis (p. 8, eczema as part of atopic diathesis). • Seborrhoeic dermatitis (p. 20, exaggerated involvement of scalp, face, and flexures). • Systematized allergic contact/chronic actinic dermatitis (pp. 18, 22, history of eczema initially in a localized area). • Drug reactions (pp. 220, 224, 226, 230, a variety of reaction patterns following medication exposure) (65).
This patient with gout developed a hypersensitivity reaction to allopurinol, resulting in erythroderma. Erythroderma 53 INVESTIGATIONS • Blood count, differential white cell count, including Sézary count (anaemia and eosinophilia is common; atypical lymphocytes are often seen and are not necessarily indicative of Sézary syndrome). • Basic chemistry, liver function tests (hypoalbuminaemia is common). • ESR, CRP (often raised). • Immunoglobulins, serum protein electrophoresis (IgE is often elevated).
The weals are generally extremely itchy. Each lesion persists for a few hours (always less than 24 hours) before resolving to leave normal skin. Urticaria is a dynamic disorder in which new weals develop as older lesions resolve (68). Patients may display positive dermographism, which is the tendency to develop linear weals at the site of gentle scratching of the skin. Acute urticaria sometimes occurs with concomitant angiooedema and rarely as part of an anaphylaxis reaction. COMPLICATIONS • Fatigue and headache.