By Daniel Creamer
Specializes in dermatoses with a unexpected onset, speedy development or with neighborhood or systemic morbidity. This name covers quite a few universal inflammatory and infective dermatoses, rarer stipulations: rashes, tumours, connective tissue affliction, travelllers' dermatoses and drug eruptions.
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The medical and medical Encyclopedia of the Nail
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Extra resources for Acute Adult Dermatology: Diagnosis and Management: A Colour Handbook
IMMEDIATE MANAGEMENT Topical therapy • General emollient therapy. • Corticosteroid ointment, twice per day (use for a restricted period): trunk, limbs: moderately potent. ) Systemic therapy • EITHER methotrexate 5 mg one dose, second dose in 5–7 days. • OR ciclosporin 3–5 mg/kg/day in two divided doses. g. infliximab IV infusion 5 mg/kg over 2–3 hr). • Acitretin 25 mg once daily can control GPP (acitretin has a relatively delayed onset of action and therefore other drugs should be considered initially).
Examination of the mouth may reveal cobblestone papules on the palate. Secondary infection of lesional skin in Darier’s disease will cause an inflammatory flare which leads to worsening itch and soreness (59). HSV infection causes erosions and haemorrhagic crusts while Staphylococcus aureus colonization produces yellow–brown crusting (60). DIFFERENTIAL DIAGNOSIS • Seborrhoeic dermatitis (p. 20, erythema and scaling of the face, scalp, and chest). • Grover’s disease (p. 50, keratotic papules on torso of sun-damaged patients).
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.