Dermatologic Emergencies Don’t Have to be “Diagnoses of Terror”

SDPA President Renata Block kicked off the 19th SDPA Fall Dermatology Conference with a warm welcome to the live and virtual attendees while thanking the volunteers and sponsors for this year’s event. President Block reminded attendees that “all of us have a voice” and the importance of representing the current and future profession of Dermatology PAs. The California Dermatology PA Society is one of 19 state dermatology PA affiliates in the U.S. and during Thursday’s address, Anne Lee, CDPA president, welcomed the attendees to the event held in Los Angeles, California.

Coverage: SDPA 19th Annual Fall Dermatology Conference in Los Angeles Nov. 4-7, 2021

Misha Rosenbach, MD, associate professor and physician, Penn Medicine, started off the morning with his illuminating lecture discussing dermatologic emergencies titled “Diagnoses of Terror.” Dr. Rosenbach reminded attendees that Steven-Johnson Syndrome (SJS) is not the only dermatology emergency.  He defined severe drug eruptions as those which prolong or lead to hospitalizations or are associated with adverse outcomes of significant morbidity and mortality. Toxic epidermal necrolysis (TEN) was reviewed emphasizing the importance of early recognition of the condition through identification of erosions, inducible blistering (Nikolsky sign), non-blanching erythema, and painful targetoid lesions. SJS and TEN reactions are almost always drug induced and there is an increased risk in those who are immunocompromised.  Lamotrigine has been identified as a medication with higher risk of development of SJS and as such is typically prescribed in slow titrating dosing. Further discussion by Dr. Rosenbach reviewed differentiating TEN and SJS as well as rare medication causes of SJS/TEN. Management of SJS/TEN was discussed with the main goal being “to keep the skin moist and avoiding extra trauma”.

Next, Drug Reaction and Eosinophilia and Systemic Symptoms (DRESS) was highlighted with the main features of presentation almost always including facial involvement with facial erythema and edema. Patients who present with DRESS will present with CBC abnormalities which may include eosinophilia or an atypical leukocytosis. Hand edema is present in up to a one third of patients with DRESS. Dr. Rosenbach emphasized that long term follow-up of patients with DRESS is important to monitor for delayed autoimmune reactions which is present in up to 10% of patients.

Additional conditions discussed by Dr. Rosenbach includes acute generalized exanthematous pustulosis (AGEP), vasculitis and vasculopathies.

Pictured: SDPA Board of Directors President Renata Block, MMS, PA-C

By: Sarah B. W. Patton, PA-C