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Last updated on 26 Jan 2016 at 3:14 PM (Derm06)
Blisters
A 75 year old Chinese man presents to the Emergency Department in winter with
blisters and a red blotchy rash. Ten days ago he was started on carbamazepine for
painful diabetic neuropathy.
Applied Science for Medicine
Microanatomy of the dermis and epidermis
Pathogenesis of the different types of cutaneous drug reactions
Pathogenesis of autoimmune bullous disease (bullous pemphigoid and pemphigus)
Physiological effects of significant skin loss from cutaneous drug reactions
Pharmacogenetic variability; recognise genetic susceptibility to drug reactions
Explain the effect of a sensory neuropathy on the skin
Clinical and Communication Skills
Take an effective history being mindful of the differential diagnosis of acute and nonacute blistering diseases and the importance of an accurate drug history
When necessary identify the need for the use of an interpreter
Examination of a patient with blisters noting site, size, flaccidity, distribution of
blisters, signs of mucous membrane and systemic involvement
Describe cutaneous features in dermatological terminology
Outline appropriate investigations including the importance of skin biopsy and
immunofluorescence for accurate diagnosis
Manage, report and avoid adverse drug reactions; use of medic alert bracelet,
automated computer alerts; notification to Centre for Adverse Reactions Monitoring
(CARM)
Provide the patient with verbal and written information about the skin disorder
diagnosed
Personal and Professional Skills
Principles of prevention of adverse drug reactions
Establish a multidisciplinary approach to severe drug eruptions with the involvement
of dermatology, general medicine, ophthalmology, gynaecology and intensivists
Liaise effectively with family/whĕnau and allied health professionals for an
assessment of the home environment
Hauora MÄ•ori
Culturally safe engagement with this patient and whĕnau
Consideration of access to cultural / spiritual support for patient and whĕnau
Population Health
Pharmacogenetic screening for susceptibility to drug reactions where needed
Conditions to be considered relating to this scenario
Common
Less common but
'important not to miss'
Uncommon
drug eruption (mild), erythema ab igne
drug eruption (major), Stevens Johnson syndrome,
toxic epidermal necrolysis, erythema multiforme, drug
hypersensitivity syndrome/drug reaction with
eosinophilia and systemic symptoms (DRESS)
bullous pemphigoid, pemphigus vulgaris, dermatitis
herpetiformis, cutaneous vasculitis +/- systemic
involvement