Monday 15 November 2010

MRCP revision battle 50.1: Gangrene and Necrotising Fasciitis

A day dedicated to dermatology...


MRCP revision battle 50.1: Gangrene and necrotising fasciitis
MRCP revision battle 50.2: Acne Rosacea
MRCP revision battle 50.3: Seborrhoeic dermatitis
MRCP revision battle 50.4: Alopecia
MRCP revision battle 50.5: Discoid lupus erythematosus
MRCP revision battle 50.6: Bullous Pemphigoid and Pemphigus Vulgaris
MRCP revision battle 50.7: Erythrasma




MRCP revision battle 50.1: Gangrene and necrotising fasciitis


A couple of grim topics: gangrene and necrotising fasciitis.


Gangrene

Gangrene is death of tissue due to ischaemia.  It can be subdivided into:
  • dry gangrene = ischaemia only
  • wet gangrene = ischaemia plus infection

Management is surgical with debridement and IV antibiotics



Necrotising fasciitis 




Necrotising fasciitis is a rapidly spreading infection of the deep fascia.


Type 1 is caused by mixed anaerobes and aerobes, classically occuring in diabetes and post surgery
Type 2 is usually caused by streptococcus pyrogenes, which is a group A beta haemolytic strep.



Fournier's gangrene is a subtype of necrotising fasciitis which affects male genitalia/the perineal area.
Meleney's gangrene is a subtype of necrotising fasciitis which occurs after an operation


Treatment of necrotising fasciitis is with debridement.



Mortality is around 70%.



Onwards to acne rosacea...