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Dermatology > 3. Urticaria > Flashcards

3. Urticaria Flashcards

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Dermatology Board Prep flashcards
1
Q

Compare Urticaria with Angio edema in 4 major characteristics?

A

Urticaria: تورم گذرای سطحی پوست به دلیل نشت پلاسما

  1. Pruritic
  2. Well defined border
  3. Red with Central Pallor
  4. Transient (less than 24 hrs)

Angioedema: تورم بافت های عمقی تر پوست

  1. Painful
  2. Not well defined border
  3. All red
  4. Lasts for 2-3 days
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2
Q

What are the two cells responsible in Urticaria and what is their roll?

A
  1. Mast Cells are the primary effector cell of urticaria. They release Histamine when Fc receptor is activated by IgE-Antigen complex
  2. Eosinophils are responsible for Persistence of wheals
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3
Q

What is Pathogenesis of Chronic Urticaria?

A

IgG Auto-antibody binds to Fc receptor on the surface of mast cells and release histamine

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4
Q

What is pathogenesis of Vasculitis Urticaria?

A

رسوب کمپلکس ایمنی (افزایش حساسیت تیپ ۳) باعث ایجاد ان می شود

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5
Q

What can cause Non-immunologic activation of mast cells?

A 
Morphin
Codein
Vancomycin
NSAID
Radiocontrasts
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6
Q

What is Vasculitis Urticaria?

A

ضایعات کهیری که بیش از ۲۴ ساعت باقی بمانند مطرح کننده ی واسکولیت است. در واقع این واسکولیت ها تظاهری شبیه کهیر دارند

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7
Q

Usually angio-edema is accompanied by urticaria except in :

A
  1. Hereditary angioedema

2. Angioedema due to ACE inhibitor

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8
Q

How do you categorize urticaria into Acute and Chronic?

A

Less than 6 weeks –> acute

6 or More than 6 weeks with at least 2 times per week incidence of wheal –> Chronic

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9
Q

Most Common Cause of Acute Urticaria?

A

Atopic Dermatitis in Children

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10
Q

Most Common Cause of Chronic Urticaria?

A

در دهه چهارم زندگی بزرگسالان که با بیماری های اتوایمیون ارتباط دارد

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11
Q

کهیر مزمن با چه عواملی ارتباط دارد؟

A
  1. Auto-immune dieseases :
    Autoimmune thyroiditis, Vitiligo, DM, RA, Pernicious Anemia
  2. H. Pylori
  3. Parasites: SS
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12
Q

How to differentiate Vasculitis Wheal from a simple Wheal?

A

Vasculitis Wheal is:

  1. Lasts longer than 24hrs
  2. Painful rather than Pruritic
  3. برجا گذاشتن کبودی
  4. elevated ESR
  5. Associated with Fever, Arthritis, Cough, nephritis, Lymphadenopathy
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13
Q

What are the physical urticaria?

A
  1. Dermographic
  2. Delayed Pressure urticaria
  3. Cold Urticaria
  4. Cholinergic Urticaria
  5. Solar Urticaria
  6. Vibratory urticaria
  7. Aquagenic urticaria
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14
Q

All the physical urticaria occurs after a few minutes after contact with a specific stimuli except:

A
  1. Delayed Dermographism

2. Delayed Pressure Urticaria

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15
Q

What are the 2 types of Dermographism?

A 
2 types:
1. Immediate type: 
Most common.
در محل خراشیدگی پوست کهیر ایجاد می شود
درگیری مخاطی معمولا ندارد
 ارتباطی با بیماری سیستمیک، آتوپی، آلرژی غذایی، اتوایمیونیتی ندارد
  1. Delayed type:
    Rare
    Occurs at least 30 minutes after Excoriation
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16
Q

What is Delayed Pressure Urticaria?

A

سی دقیقه تا ۱۲ ساعت پس از فشار مداوم به پوستو تورم عمقی شبیه انژیوادم ایجاد می کند که معمولا همراه با خارش یا درد است و ممکنه چن روز طول بکشه

17
Q

What are Systemic presentation of Delayed Pressure Urticaria?

A

Malaise
Flu like Symptoms
Arthralgia

18
Q

On which part of body does Delayed Pressure Urticaria occur most probably?

A
  1. دور کمر با پوشیدن لباس تنگ
  2. زیر جوراب الاستیک
  3. پا با کفش تنگ
  4. کف دست پس از کار زیاد
  5. کف پا بعد از راه رفتن یا بالا رفتن از نردبان
  6. ناحیه تناسلی بعد از رابطه جنسی
19
Q

What is Cold Urticaria?

A

پس از تماس با محیط سرد و در حین گرم شدن رخ میده
معمولا ایدیوپاتیکه اما ممکنه بعد از عفونت تنفسی یا گزش حشرات هم رخ بده
چون ممکنه در سطح وسیعی از پوست ایجاد شود و باعث فلاشینگ و انافیلاکسی شود توصیه می شود که این افراد استحمام یا شنا در آب سرد نروند

20
Q

What is Cholinergic Urticaria?

A

پاپول ۲ تا ۳ میلی متری گذرا ایجاد می کنند
پس از محرک هایی که باعث ایجاد عرق می شوند مثل فعالیت فیزیکی، حمام آب گرم، استرس هیجانی ایجاد میشود

بیشتر در قسمت فوقانی بدن به صورت متقارن ظاهر می شود

21
Q

What is Treatment Drugs for Urticaria?

A

H1 Blocker:
Not Sedative: Cetirizine
less Sedative: Loratadine
more Sedative: Hydroxyzine

H2 blocker: Ranitidine
H1 and H2 blocker: Doxepin (TCA)
Chlorpheniramine

22
Q

What is the treatment plan for urticaria?

A

1st we start with No/Low Sedative H1 blocker. If it fails we increase the dose. If it fails again we add more Sedative H1 blocker right before sleep. If it’s not successful yet we add H2 blocker to the regimen.
In the case of resistance we could prescribe Doxepine

We use Chlorpheniramine for Pregnant women

For Acute severe Urticaria we could use SYSTEMIC corticosteroid, but it’s not appropriate for Chronic Uritcaria

In case of Anaphylaxis or Laryngeal edema Epinephrin is the drug of choice. People with history of anaphylaxis should carry 2 epinephrine auto-injectors with themselves

23
Q

What is the Pathogenesis of Hereditary Angio-edema?

A

Decrease in number of C1 esterase INHIBITORS (type 1 more common)
Dysfunction in the C1 inhibitor (type 2, only 15 %)

C1 esterase activates Kallikrein and it produces Bradykinin causing angio-edema

24
Q

What are the signs of Hereditary angio-edema?

A

Swelling of the Face, Oropharynx, Extremities and Genital area and Abdominal Pain
Its hardly associated with urticaria

25
Q

What is the Screening test for Hereditary angio-edema?

A

Measuring C4 level bc C4 level is LOW even between attacks

C2 level is low only during attacks

26
Q

How Could Hereditary Angio Edema be life threatening?

A

Swelling of Oropharynx could cause airway obstruction which may require Tracheostomy.

27
Q

What is the treatment for Hereditary angio-edema?

A
  1. Ecallantide (Kallikrein inhibitor) for treatment of attacks
  2. Icatibant (Bradykinin Antagonist) for treatment of attacks
  3. Danazol or Stanazolol (androgen) (increase synthesis of C1 inhibitor in liver) for reducing the attacks
  4. Prophylactic FFP for prevention of attacks before surgery
28
Q

What is Hereditary Angio-edema Contraindication for?

A
  1. ACEI

2. Estrogens

29
Q

What is PUPP (Pruritic Urticarial Papule and Plaques)?

A

شایعترین ضایعه خارش دار در بارداری است که در سطح شکم، باسن و اندام های پاپول و پلاک خارش دار ایجاد می شود

30
Q

What is the Diagnosis test for PUPP?

A

immunofluorescence on the biopsy specimen from the skin

که برخلاف پمفیگویید بارداری رسوب انتی بادی یا کمپلمان مشاهده نمی شود

31
Q

What is the treatment for PUPP?

A

دارو های ضد خارش و استرویید موضعی و در صورت مقاومت استرویید خوراکی

Dermatology (9 decks)

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