docJean-Claude Roujeau Francisco A. Kerdel
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Jean-Claude Roujeau Francisco A. Kerdel
Life-Threatening Dermatoses and Emergencies in Dermatology Jean Revuz • Jean-Claude Roujeau Francisco A. Kerdel • Laurence Valeyrie-Allanore Editors Life-Threatening Dermatoses and Emergencies in Dermatology Editors Jean Revuz Service de Dermatologie Centre hospitalier universitaire Henri Mondor 51 av du Maréchal de Lattre de Tassigny 94010 Créteil, France [email protected] [email protected] Jean-Claude Roujeau Université Paris XII Service de Dermatologie Centre hospitalier universitaire Henri Mondor 51 av du Maréchal de Lattre de Tassigny 94010 Créteil, France [email protected] Francisco A. Kerdel Cedars Medical Center Department of Dermatology 1400 NW 12 Avenue 6th South Miami, FL 33136, USA [email protected] Laurence Valeyrie-Allanore Service de Dermatologie Centre hospitalier universitaire Henri Mondor 51 av du Maréchal de Lattre de Tassigny 94010 Créteil, France [email protected] ISBN 978-3-540-79338-0 e-ISBN 978-3-540-79339-7 DOI: 10.1007/978-3-540-79339-7 Library of Congress Control Number: 2008935634 © 2009 Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Spain Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com Preface For many reasons, dermatology has acquired a special status among medical specialties. As the most accessible organ, skin was from the origin of humanity frequently exposed to therapeutic interventions and manipulations by spouses, wizards, physicians, artists and scientists. With the tremendous development of science in the 19th century, dermatology benefited early from the most advanced technologies. Photography, bacteriology, and pathology proved especially efficient for studying skin diseases. The “clinical-pathological” method arose as the gold standard for describing a myriad of diseases. As a consequence, dermatology textbooks became two to three times thicker than internal medicine textbooks. As a heritage from this caricatural historical background, the definitions and boundaries of dermatological diseases are more complicated and controversial than the borders of Caucasian countries and regions. Too many physicians, rebuffed by its confusion and complexity, have a poor knowledge of dermatology, and seldom appreciate the impact and consequences of skin disease. Most of them underestimate the physiological role of the skin as an organ, as important for life as any other one. Nearly all, including some dermatologists, are skeptical regarding the very concept of “dermatological emergencies”. This concept of emergency in dermatology is nevertheless very familiar to patients. Who would not be frightened by the brutal occurrence of fever and a painful rash? Family physicians and emergency physicians are therefore frequently confronted with acute skin lesions. It matters little if they do not give an adequate diagnosis to the 90% that are benign or not clinically significant. On the other hand, they should not miss those that are dangerous, either through a direct impact on the function of the skin or as marker of a serious systemic disease. The editors of this book, all of whom have worked in hospital units specialized in lifethreatening dermatological diseases, have the common experience that diagnoses with prominent cutaneous manifestation are often delayed, resulting in less than adequate management. One major aim of this book was therefore to help general practitioners, emergency room physicians, and intensive care specialists to recognize life-threatening dermatoses and to better interpret the skin symptoms of acutely ill patients. Another important goal was to remind dermatologists that they may, like every other medical specialist, be on the front line to fight life-threatening diseases, and that they v vi Preface should not miss the occasional dangerous disease that may hide behind a common skin manifestation. The format of this book was designed to support these aims. There are often several entries for a single disease: (1) by dermatological diagnosis, (2) by presenting skin symptoms with a decisional tree emphasizing urgent diagnoses that should not be missed, and (3) by risk factors (associated diseases, immunosuppression, etc.) As any multi-authored book, this one has not avoided duplications, expression of different points of view and, occasionally, contradictions. As far as contradictions concerning matters of classification, mechanisms of action and investigation priorities, they were respected by the Editors. In settings where emergency management was concerned, we tried to solve all discordant point of views based on the best available evidence, even if often the evidence was poor. September 2008 Jean Revuz Jean-Claude Roujeau Francisco A. Kerdel Laurence Valeyrie-Allanore Contents Part I: Skin Physiology 1 Skin Barrier .............................................................................................. Joachim W. Fluhr and Razvigor Darlenski 3 2 Skin Immune System ............................................................................... István Nagy and Lajos Kemény 19 3 Bacteriology of the Skin........................................................................... Cristina Oprica 29 4 Acute Skin Failure .................................................................................... Laurence Valeyrie-Allanore, Saskia Oro, and Jean-Claude Roujeau 37 Part II: Life Threatening Dermatoses 5 Purpura Fulminans .................................................................................. Saul N. Faust and Simon Nadel 6 Severe Infections of Soft Tissues (Including Fasciitis and Diabetic Foot Infections)................................. Philippe Bernard 57 Severe Staphylococcal Cutaneous Infections and Toxic Shock Syndrome.................................................... Isabel C. Valencia and Francisco A. Kerdel 67 7 8 Erythroderma and Exfoliative Dermatitis ............................................. Michelle A. Thomson and John Berth-Jones 9 Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis .................................................................................................. Maja Mockenhaupt 45 79 87 vii viii 10 Contents Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS/DIHS) ...................................................................... Koji Hashimoto, Mikiko Tohyama, and Tetsuo Shiohara 97 11 Acute Generalized Exanthematous Pustulosis ...................................... Alexis Sidoroff 103 12 Autoimmune Bullous Diseases................................................................. Pascal Joly 111 Part III: Cutaneous Manifestation in Life Threatening Diseases 13 Skin Manifestations of Systemic Bacterial Infections........................... Pascal del Giudice and Olivier Chosidow 123 14 Severe Mycoses in Immunodepressed Patients ...................................... Delphine Kerob, Martine Feuillhade-de-Chauvin, and Celeste Lebbe 133 15 Skin Manifestations Associated with Malignant Haemopathies ........................................................................................... Sélim Aractingi and Boutros Soutou 16 Skin Manifestations Useful for the Management of Patients in an Intensive Care Unit or an Emergency Room .......................................................................... Camille Francès 145 155 Part IV: Specific Context 17 Emergencies in the Dermatologist’s Office ........................................... Dominique Penso-Assathiany 18 Life-Threatening Dermatoses Occurring During Gestation ...................................................................................... Kiarash Khosrotehrani 175 Main Life-Threatening Dermatoses in Neonatal Period and in Infancy ......................................................... Christine Bodemer 181 19 20 21 Life-Threatening Dermatoses and Emergencies in Dermatology: The Case of the Paediatric Patient ............................ Christine Léauté-Labrèze, Franck Boralevi, and Alain Taïeb Extreme Poverty in Industrial Countries .............................................. Lise Lavillonnière 165 189 199 Contents ix 22 Life-Threatening Dermatoses and Emergencies in Dermatology in the Specific Context of the Extreme Poverty of the ‘Third World’ ................................................................... Fatimata Ly 207 23 Noxious Spider Bites ............................................................................... Batya B. Davidovici and Ronni Wolf 215 24 Frostbite Injury Management in Emergency ........................................ Emmanuel Cauchy, Scrimgeour Carron, Rik Verhellen, and Fontanille Bernard 223 25 Photodermatoses ...................................................................................... M.-T. Leccia and J.-C. Beani 235 26 Life-Threatening Dermatoses and Emergencies in Migrants and Patients Coming Back from a Tropical or Subtropical Country ................................................ Eric Caumes 241 27 Telemedicine in Skin Emergencies ......................................................... Jim Muir, Terri M. Campbell, and H. Peter Soyer 247 28 Skin Diseases in Bioterrorism ................................................................ John A. Ebner and Kenneth J. Tomecki 253 29 Life-Threatening Complications of Dermatologic Therapies ...................................................................... Bénédicte Lebrun-Vignes 267 Part V: Diagnostic Charts for the Skin Signs in the Acutely Ill Patient 30 Mechanisms of Pupura, Livedo, Necrosis .............................................. Jean-Claude Roujeau 279 31 Skin Necrosis ............................................................................................ Zuleika L. Bonilla-Martinez and Robert S. Kirsner 281 32 The Patient with Purpura in the ICU or in the Emergency Room...................................................................... Dan Lipsker 33 Livedo ........................................................................................................ Julia S. Lehman, Arlo J. Miller, Megha M. Tollefson, and Lawrence E. Gibson 289 295 x Contents 34 Diagnosis of Blisters and Vesicles ............................................................ L. Valeyrie-Allanore 303 35 Diagnosis of Disseminated Pustulosis ..................................................... Jean Revuz 307 36 Diagnosis of Face Oedema ....................................................................... Marion Gabillot-Carré 311 37 Diagnosis of Oral Lesions ........................................................................ Loïc Vaillant and Laurent Machet 313 38 Acute Urticaria and Anaphylaxis ............................................................ Catherine Pecquet 315 Exanthematic Rash .................................................................................. Bruno Sassolas 319 Index .................................................................................................................. 325 39 Contributors Sélim Aractingi, MD, PhD Service de Dermatologie Allergologie, Hôpital Tenon, 75020 Paris, France, and Equipe 15, CDR Inserm UMRS 893 St Antoine, 27, rue de Chaligny, 75012 Paris, France email: [email protected] Jean-Claude Beani, MD Dermatologie, Pôle Pluridisciplinaire de Médecine, CHU Albert Michallon, 38043 Grenoble cedex, France email: [email protected] Fontanille Bernard, MD IFREMMONT, Institut de Formation et de Recherche en Médecine de Montagne, Hôpital de Chamonix, 509 route des Pèlerins, 74400 Chamonix, France www.ifremmont.com Philippe Bernard, MD Department of Dermatology, Robert Debré Hospital, 51092 Reims cedex, France email: [email protected] John Berth-Jones, MD Department of Dermatology, University Hospital, Coventry CV2 2DX, UK email: [email protected] Christine Bodemer, MD Service de Dermatologie, Hôpital Necker, 149 Rue de Sèvres, 75015 Paris, France email: [email protected] Zuleika L. Bonilla-Martinez, MD Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA email: [email protected] Franck Boralevi, MD Pediatric Dermatology Unit, Children’s Hospital, National Reference Center for Rare Skin Disorders, CHU de Bordeaux, Place Amélie Raba-Léon 33076 Bordeaux Cedex, France T.M. Campbell, MD Dermatology Group, School of Medicine, Southern Clinical Division, The University of Queensland, Brisbane, Australia email: [email protected] Scrimgeour Carron, MD IFREMMONT, Institut de Formation et de Recherche en Médecine de Montagne, Hôpital de Chamonix, 509 route des Pèlerins, 74400 Chamonix, France www.ifremmont.com xi xii Emmanuel Cauchy, MD IFREMMONT, Institut de Formation et de Recherche en Médecine de Montagne, Hôpital de Chamonix, 509 route des Pèlerins, 74400 Chamonix, France www.ifremmont.com Eric Caumes, MD Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, 45-83 Bld de l’hôpital, 75013 Paris, France email: [email protected] Olivier Chosidow, MD Université Paris VI and Service de dermatologie et d’allergologie, Hôpital Tenon, 4 rue de la chine, 75020 Paris, France email: [email protected] Razvigor Darlenski Department of Dermatology and Venereology, Medical Faculty-Sofia, Bulgaria Batya B Davidovici, MD Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel email: [email protected] John A. Ebner, DO The Cleveland Clinic, Dermatology / A61, 9500 Euclid Avenue, Cleveland, OH 44195, USA email: [email protected] Saul N. Faust, MRCPCH PhD FHEA Senior Lecturer in Paediatric Infectious Diseases, and Immunology & Acting Director, University of Southampton, Wellcome Trust Clinical Research Facility, Mailpoint 218, Level C West Wing, Southampton University Hospital, NHS Trust, Tremona Road, Southampton SO16 6YD, UK email: [email protected] Martine Feuillhade-de-Chauvin, MD Department of Mycology, Hôpital Saint Louis, 1 avenue Vellefaux, 75010 Paris, France email: [email protected] Joachim Fluhr, MD Medical Director, Bioskin, Seydelstrasse 18, 10117 Berlin, Germany email: [email protected] Camille Frances, MD Service Dermatologie, Hôpital Tenon, 4 rue de la chine, 75020 Paris, France email: [email protected] Marion Gabillot-Carré, MD 7 Avenue des Jardins, 74200 Thonon, France email: [email protected] Lawrence E. Gibson, MD Department of Dermatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA email: [email protected] Pascal del Giudice, MD Infectiology and Dermatology Department, Hôpital Bonnet, 83600 Fréjus, France email: [email protected] Contributors Contributors xiii Koji Hashimoto, MD Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan email: [email protected] Pascal Joly, MD Clinique Dermatologique, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex, France email: [email protected] Lajos Kemény, MD Department of Dermatology and Allergology, University of Szeged, Korányi fasor 6, 6701 Szeged, Hungary, and Dermatological Research Group of the Hungarian Academy of Sciences and the University of Szeged Korányi fasor 6, 6701 Szeged, Hungary Francisco A. Kerdel, MD Cedars Medical Center, Department of Dermatology, 1400 NW 12 Avenue, 6th South, Miami, FL 33136, USA email: [email protected] Delphine Kerob, MD Department of Dermatology, Hôpital Saint Louis, 1 avenue Vellefaux, 75010 Paris, France email: [email protected] Kiarash Khosrotehrani, MD Assistant Professor in Dermatology, Department of Dermatology and Allergology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France and Developmental Physiopathology Laboratory, Team 15, INSERM UMR_S893, Saint-Antoine Research Center, UPMC Paris 6, University School of Medicine, 27 rue de Chaligny, 75012, Paris, France email: [email protected] Robert S Kirsner, MD PhD Department of Dermatology, University of Miami, P. O. Box 016250 (R250), Miami, 33101, USA email: [email protected] Lise Lavillonnière, MD 19 rue Bobillot, 75013 Paris, France email: [email protected] Christine Léauté-Labrèze, MD Hôpital Pellegrin-Enfants, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France email: [email protected] Celeste Lebbe, MD Department of Dermatology, Hôpital Saint Louis, 1 avenue Vellefaux, 75010 Paris, France email: [email protected] Bénédicte Lebrun-Vignes, MD Dermatologue, Pharmacologue, Praticien Hospitalier, Responsable du Centre, Régional de Pharmacovigilance du groupe hospitalier Pitié-Salpêtrière, Service de Pharmacologie, 47 boulevard de l’Hôpital, 75013 Paris, France email: [email protected] Marie-Thérèse Leccia, MD Dermatologie, Pôle Pluridisciplinaire de Médecine CHU Albert Michallon, 8043 Grenoble cedex, France email: [email protected] xiv Contributors Julia S. Lehman, MD Department of Dermatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA email: [email protected] Dan Lipsker, MD Clinique Dermatologique, 1, Place de l’hôpital, 67091 Strasbourg Cedex, France email: [email protected] Fatimata Ly, MD Dermatologue Vénéréologue, Institut d’Hygiène Sociale de Dakar, BP 5825 Dakar Fann, Sengal email: [email protected] Laurent Machet, MD Service de Dermatologie, Centre hospitalier universitaire, 37044 Tours cedex 09, France email: [email protected] Arlo J. Miller, MD PhD Department of Dermatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA email: [email protected] Maja Mockenhaupt, MD Dokumentationszentrum schwerer Hautreaktionen (DZH), Universitäts-Hautklinik Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany email: [email protected] Jim Muir, MD Dermatology Group, School of Medicine, Southern Clinical Division, The University of Queensland, Princess Alexandra Hospital, Brisbane QLD 4102, Australia email: [email protected] Simon Nadel, FRCP Consultant in Paediatric Intensive Care, Department of Paediatrics, St. Mary’s Hospital and Imperial College London, Praed Street, London, W2 1NY, UK email: [email protected] István Nagy, MD Institute for Plant Genomics, Human Biotechnology and Bioenergy, Bay Zoltán Foundation for Applied Research, Pf 1281, 6726 Szeged, Hungary email: [email protected] Cristina Oprica, MD Karolinska University Hospital, Department of Dermatology and Venereology I 43, 141 86 Stockholm, Sweden email: [email protected] Saskia Oro, MD Department of Dermatology, Hôpital Henri Mondor Université ParisXII, Inserm U841, 51 ardu Maréchal de Lattre de Tassigny, 94010 Créteil, France email: [email protected] Catherine Pecquet, MD Dermatologie Allergologie, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75970 Paris cedex 20, France email: [email protected] Dominique Penso-Assathiany, MD Moulineaux, France email: [email protected] 30 av Victor Cresson, 92130 Issy les Contributors xv Jean Revuz, MD Service de Dermatologie, Centre hospitalier universitaire Henri Mondor, 51 av du Maréchal de Lattre de Tassigny, 94010 Créteil, France email: [email protected], [email protected] Jean-Claude Roujeau, MD Service de Dermatologie, Centre hospitalier universitaire Henri Mondor, Université Paris XII, 51 av du Maréchal de Lattre de Tassigny, 94010 Créteil, France email: [email protected] Bruno Sassolas, MD University of Bretagne Occidentale, Department of Dermatology, CHU Brest, 29609 Brest cedex, France email: [email protected] Tetsuo Shiohara, MD Department of Dermatology, Kyorin University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan Alexis Sidoroff, MD Department of Dermatology and Venereology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria email: [email protected] Boutros Soutou Service de Dermatologie Allergologie, Hôpital Tenon, 75020 Paris, France email: [email protected] H. Peter Soyer, MD The Queensland Institute of Dermatology, School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane QLD 4102, Australia email: [email protected] Alain Taïeb, MD Hôpital Pellegrin-Enfants, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France email: [email protected] Michelle A Thomson, MD Consultant Dermatologist, Department of Dermatology, City Hospital, Dudley Road, Birmingham B18 7QH, UK Mikiko Tohyama, MD Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan Megha M. Tollefson, MD Department of Dermatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA email: [email protected] Kenneth Tomecki, MD The Cleveland Clinic, Dermatology / A61, 9500 Euclid Avenue, Cleveland, OH 44195, USA email: [email protected] Loïc Vaillant, MD Université François Rabelais, 3 rue des Tanneurs, BP 4103, 37041 Tours Cedex 01, France email: [email protected] Isabel C. Valencia, MD Department of Dermatology and Cutaneous Surgery, 1600NW 10th Avenue, Rosenstiel Medical Science Building, Room 2023A (R-250), Miami, FL 33136, USA email: [email protected]
