The proper treatment for common dermatologic conditions presenting in the ED, like psoriasis, plant-based dermatitis, and eczema, is not always as easy to identify as the rash itself. As part of her “Dermatology Update 2014: New Treatments, Classic Conditions” talk, Heather Murphy-Lavoie, MD, assistant residency director of the emergency medicine residency program and associate program director of the hyperbaric medicine fellowship at the Louisiana State University School of Medicine in New Orleans, will review these and other common skin conditions typically seen in the ED and discuss both traditional and new treatment options.
Explore This IssueACEP14 Daily News Wednesday: Vol 33 - No10C - October 2014
“The starting point is to decide what type of rash it is—maculopapular, petechial, purpuric, vesiculobullous, [or] sloughing,” Dr. Murphy-Lavoie said. “Then look at [a patient’s] vital signs for fever or signs of systemic toxicity.” She cited the failure to immediately prescribe broad-spectrum antibiotics to patients with bacteremia as one of the pitfalls of not properly diagnosing certain dermatologic conditions in the ED.
Failure to consider thrombotic thrombocytopenic purpura in those patients with nonpalpable petechiae and administration of platelets to those patients can exacerbate an otherwise easily treatable condition, Dr. Murphy-Lavoie said. She also advised emergency providers to educate their patients on the risk of transmitting contagious rashes to infants, elderly people, pregnant women, and people with compromised immune systems.
Dr. Murphy-Lavoie will discuss new treatment options, including dalbavancin and tedizolid for the treatment of methicillin-resistant Staphylococcus aureus. “These show equivalent efficacy to vancomycin, but dalbavancin can be dosed once weekly and tedizolid has an oral formulation,” she said. Attendees should understand the new treatment guidelines for skin and soft-tissue infections published by the Infectious Diseases Society of America in June 2014.1
Overall, providers should be aware of these common conditions and the appropriate ways to treat them. “Be on the lookout for measles, syphilis, drug-induced vasculitis,” she advised.
Michael O’Neal is a writer based in New Jersey.
1. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:147-5.