Acute Inflam. Dermatoses

Question 1

Level of Skin Affected by Urticaria

Answer 1

Dermis

Question 2

Level of Skin Affected by Erythema Multiform

Answer 2

Epidermis & Dermis

Question 3

Level of Skin Affected by Steven Johnson Syndrome/Toxic Epidermal Necrolysis

Answer 3

Epidermis & Dermis

Question 4

Level of Skin Affected by Panniculitis

Answer 4

Subcutaneous

Question 5

Acute Inflammatory Dermatoses & the level of skin they affect

Answer 5

Urticaria ————– dermis
Erythema Multiform – Epi/dermis
Steven Johnson Syndrome — Epi/dermis
Toxic Epithelial Necrolysis —- Epi/dermis
Panniculitis ——————– subcutaneous

Question 6

Hallmarks of Urticaria

Answer 6

• Transient wheals (lasting ~24 hours)
• Pruritic
• IgE & Histamine related

Question 7

Angiodema Hallmarks

Answer 7

• Deep dermal & subcutaneous swelling
• burning & painful
• common around the lips and eyes
• laryngeal involvement = EMERGENCY

Question 8

Clues & Methods of Diagnosing Urticaria & Angiodema

Answer 8

• THOROUGH HISTORY
  
  • new meds?
  • exposure?
  • foods?

Question 9

Acute vs. Chronic Urticaria & Angiodema

Answer 9

Acute
	- usually allergic (IgE) response
	- most resolve within days
Chronic
	- idiopathic (cause unknown)
	- lasts >6 weeks

Question 10

Causes of Urticaria & Angiodema

Answer 10

• Immune
  
  • IgE
  • Autoimmune
  • infection
• Non-immune
  
  • physical contact
  • direct mast-cell degranulation
  • food w/ high histamine

Question 11

Urticaria/Angiodema Immune Rxn. Causes

Answer 11

• Foods — shellfish, peanuts, fish, eggs, nuts, soy, etc
• Latex
• Stings (bees, wasps, ants, etc)
• Medications (penicillin, sulfa, etc)
• Aeroallergens (pollen, molds, etc)

Question 12

Autoimmune rxn. causing Urticaria/Angiodema

Answer 12

• Hashimoto Immune Thyroiditis
  
  • anti-thyroid AB’s
• System Lupus Erythamtous

Question 13

Infection Rxn. causing Urticaria/angiodema

Answer 13

• VIRAL
• fungal
  bacterial
  parasitic

Question 14

Physical causes of Urticaria/Angiodema

Answer 14

• Sun
• Cold
• Cholinergic (sweat & heat)
• friction
• etc

Question 15

Foods w/ high levels of histamine

Answer 15

• strawberries
• tomatoes
• shrimp
• cheese

Question 16

Urticaria Lab evals

Answer 16

1. dont get carried away –>
2. CBC & basic chem panel
3. throat culture?
4. punch biopsy to exclude vasculitis if lesion is lasting >48 hrs

Question 17

Hallmarks of Erythema Multiform

Answer 17

• Rxn. Pattern of blood vessels
  
  • circular red rash with raised center (iris shaped papules)
  • Target Lesion
• involves extremities (especially palms & soles) & mucous membranes
• NOT ITCHY
• 50% are under 20 yrs. old (mostly male)

Question 18

Types of Erythema Multiform

Answer 18

• Acute —- shows classic target lesion
• EM minor — involves 1 or less mucosal sites
• EM major — involves severe extensive skin & mucous membrane (steven johnson syndrome)
  
  • usually due to drug reaction

Question 19

Treatment of Erythema Multiform

Answer 19

• 50% are idiopathic
• Glucocorticoids for severe systemic
• prevention

Question 20

What is Erythema Multiform Major also known as?

Answer 20

Steven Johnson Syndrome

Question 21

Steven Johnson Syndrome & Toxic Epidermal Necrolysis

Answer 21

• Major problem = SLOUGHING OFF OF SKIN
• usually drug induced or idiopathic
• starts w/ skin tenderness & erythema
• mucosal & epidermal necrosis

Question 22

SJS vs. TEN

Answer 22

SJS (steven johnson syndrome)

- 30%

Question 23

SJS/TEN treatment

Answer 23

• remove drug

- HYDRATE

Question 24

Hallmarks of Panniculitis Erythema Nodosum

Answer 24

• typically ANTERIOR SHINS
• painful, tender nodules felt upon palpation
• resolves naturally w/ rest & pain control

Question 25

Hallmarks of Panniculitis Erythema Induratum

Answer 25

• Effects POSTERIOR legs

- associated with TB