Skin problems
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
A number of skin problems can occur in advanced disease, particularly dry skin, sweating, pressure ulcers and itch. A healthy skin is supple, intact and a good color, but the skin is easily compromised in advanced disease. Assessing the risk of pressure damage is important and a number of pressure sore prediction scores are available, such as the Waterlow, Norton, or Braden risk scores. Simple measures can prevent and treat a dry skin. Early damage can be difficult to identify, although one suggestion is that the skin in early damage feels warmer than surrounding skin. A hard, dark eschar of dead skin can occasionally prevent access to the ulcer, but the eschar can be softened with moist dressings. A wide range of skin disorders and systemic conditions are known to cause itching and an equally wide range of underlying mechanisms and treatments have been suggested.
Bites and burns
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The depth of the burn is classified according to the affected skin layer. Superficial or first-degree burns affect only the epidermis; these burns are erythematous and oedematous and they resolve in about a week without scarring. Partial thickness or second-degree burns are divided into superficial and deep if the papillary or reticular dermis is affected respectively. Superficial or first-degree burns do not require any special treatment. Aloe vera ointments and protection from the sun are sufficient measures to promote healing. For partial-thickness burns, excision of large blisters and debridement of the eschar under sedation is necessary for proper burn care. For most superficial partial-thickness burns, topical creams such as silver sulfadiazide followed by the application of a membrane dressing are enough. Often, large burns require extensive coverage that can be achieved only through the use of temporary substitutes such as porcine skin.
Rocky Mountain Spotted Fever
Burke A. Cunha in Tickborne Infectious Diseases, 2000
Rocky Mountain spotted fever (RMSF) is the primary rickettsial spotted fever seen in North America. Related rickettsial spotted fevers are known by various names in Latin America: Sao Paolo typhus in Brazil, Fievre Manchada in Mexico, Fievre Petequal in Columbia, and Fievre Maculosa in other countries. In Britain, it is termed tick typhus. Although RMSF of North America appears to be identical to the spotted fevers of South America, the tickborne rickettsiosis of Africa, Asia, Europe, and Australia have all been termed tick typhus. These rickettsiae are all immunologically related to R. rickettsii, the agent of RMSF. They differ in clinical presentation from RMSF in having an ulcer or eschar present at the primary site of inoculation, in contrast to RMSF which has no ulcer or eschar [1,2].
Facial eschar following a single application of black salve
Published in Clinical Toxicology, 2017
A previously healthy 86-year-old male was transported by ambulance to the trauma bay of the emergency department (ED) for profuse bleeding from the left temple. The ambulance crew raised concern that the volume and force of the bleed may suggest arterial involvement. The patient reported having applied a natural topical remedy to a mole two weeks prior at the recommendation of a naturopath. The patient described progressive blackening and swelling of the area in the days following the single application of the product. After gaining control of the bleeding in the ED, the area was found to have a raised, 2 cm eschar.
Scrub typhus (Tsutsugamushi disease) in a patient presenting with hemophagocytic syndrome
Published in Immunological Medicine, 2018
Takahiko Akagi, Tomoyuki Mukai, Shoko Tsuji, Yoshitaka Morita
Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which is found mainly in East and Southeast Asia and in Australia. The disease presents with a variety of non-specific symptoms, including fever, headache, cough, myalgia, and rash. Delay in starting appropriate antimicrobial therapy may lead to serious complications and even death. We report the case of an 84-year-old Japanese patient with scrub typhus who developed hemophagocytic syndrome (HPS) and was successfully treated with minocycline in addition to corticosteroids. A pathognomonic skin ulcer on her right buttock, which was initially covered with black eschar, prompted us to consider the possibility of scrub typhus. Blood polymerase chain reaction and antibody assays confirmed the diagnosis. Scrub typhus must be considered as one of the underlying diseases that may cause HPS in patients living in the Asia-Pacific region and in those who have recently returned from endemic areas.
Orbital ecthyma gangrenosum in multiple myeloma
Published in Baylor University Medical Center Proceedings, 2019
Ecthyma gangrenosum is a rare and highly lethal cutaneous infection classically associated with Pseudomonas aeruginosa bacteremia. We report a 58-year-old man with multiple myeloma receiving chemotherapy who presented with 2 days of painless left periorbital swelling that rapidly progressed to a blackish eschar. His absolute neutrophil count was 0.10/mm3; platelet count, 14,000/mm3; and hemoglobin, 6 g/dL. Computed tomography showed diffuse left periorbital cellulitis. Blood cultures grew pan-sensitive Pseudomonas aeruginosa, and the patient died from sepsis and multiorgan failure.