Allergic Skin Diseases

Question 1

Lesions of different eczema stages

Answer 1

• Acute stage :
  ill-defined erythematous patches, papulovesicular
  eruption with exudation of serum
• Subacute stage : erythema and scaling
• Chronic stage : dryness and lichenification

Question 2

List types of Endogenous eczema

Answer 2

• Atopic dermatitis
• Discoid eczema
• Pityriasis alba
• Stasis dermatitis
• Seborrhoeic dermatitis
• Dyshydrotic eczema (pompholyx)

Question 3

Allergic contact dermatitis is type ….. hypersensitivity

Answer 3

Type 4 hypersensitivity (sensitization dermatitis)

Question 4

Allergens in allergic contact dermatitis is

Answer 4

Incomplete antigens ( haptens )

Question 5

Atopic Dermatitis often associated with

Answer 5

A personal or family history of allergy
Itching is the constant symptom, xerotic or dry skin with loss of barrier functions

Question 6

In Infantile phase of AD lesions most frequently start on

Answer 6

Face
erythematous discrete or confluent edematous papules, intensely itchy, may become exudative and crusted

Question 7

Sites mostly involved in Childhood phase
of AD

Answer 7

elbows and knee flexures, sides of the neck, wrists
and ankles and the hands.
erythematous, edematous papules which tend to be replaced by lichenification

Question 8

sites mostly involved in neurodermatitis

Answer 8

Adulthood phase of AD
outer arms, upper back, and shin of the tibia.
lichenified plaques.

Question 9

The only type of eczema with a
demarcated edge

Answer 9

Discoid Eczema
in adults on the extensor aspects of limbs

Question 10

Lesions of Varicose Eczema (Stasis Dermatitis)

Answer 10

an erythematous scaly oozing area, surrounded by small slate blue macules resulting from hemosiderin deposits.
Ulceration around one of malleoli

Question 11

Cause of Seborrhoeic dermatitis

Answer 11

(scaly erythematous dermatitis)
seborrhea, abnormal sebum composition and the lipophilic yeast Malassezia.

Question 12

Lesion of Infantile SD

Answer 12

Greasy yellowish scales on erythematous area usually on the scalp (cradle cap), diaper area and intertriginous fold

Question 13

Leison of Adult SD

Answer 13

scaly erythematous patches involving hairy areas
and body flexures as nasolabial folds

Question 14

Lesion of Infective Eczematoid Dermatitis

Answer 14

area of erythematous patches with exudation and crustation around
a discharging focus

Question 15

Cause of Dyshydrotic Eczema (Pompholyx)

Answer 15

In heavily perspiring individuals
as an allergic reaction to a distant focus of infection as tinea pedis.

Question 16

Site of Pompholyx

Answer 16

acute or subacute vesicular eruption starting usually on the
sides of the fingers and toes and extending to soles

Question 17

Lesion in Pityriasis Alba

Answer 17

rounded, oval patch or
erythematous plaques with fine
lamellar or branny whitish scaling in children leaving scaling and hypopigmentation

Question 18

DD of Pityriasis Alba

Answer 18

Pityriasis versicolor
In alba lesion is ill-defined, skin is dry, more in children

Question 19

TTT of Eczema

Answer 19

1. Topical
   - Acute eczema :
   Compresses as potassium permanganate solution 1/8000 , 1/10.000 of lead subacetate solution 0.5% for oozing cases + topical corticosteroid cream
   - subacute eczema: Corticosteroid creams.
   - chronic eczema: Topical corticosteroid ointments
   long-term use of emollients in atopic dermatitis
2. Systemic :
   Antibiotics, Corticosteroids, Antihistamines

Question 20

1ry leison of urticaria

Answer 20

Wheels

Question 21

Layers involved in urticaria

Answer 21

Wheals in upper dermis
Angioedema in lower dermis and SC tissue

Question 22

Immunologic (Allergic cause) of urticaria

Answer 22

classic type І hypersensitivity reaction

Question 23

Mention different types of wheals

Answer 23

1. Acute : idiopathic or following URTI
2. Chronic : autoimmune process
3. Physical : solar, cholinergic….
4. Urticarial vasculitis : type III hypersensitivity reaction,more than 24h, causes: drugs, HCV and autoimmune
   connective tissue disease

Question 24

Management & TTT of urticaria

Answer 24

• 1st line : Non sedating antihistamines (second generation), daily for 2-3 weeks
• Ant-IgE (Omalizumab) or cyclosporin for chronic urticaria, SC monthly
• Systemic steroids : in severe acute urticaria for a short time
• Adrenaline 1/1000 1cc subcutaneously :
  the first line treatment of anaphylaxis, angioedema and impending airway obstruction
  (contraindicated in hypertension and heart disease).

Question 25

PAPULAR URTICARIA is a type......hypersensitivity

Answer 25

type IV hypersensitivity to insect bites. chronic and recurrent eruption of irritable edematous papules affecting infants and children.

Question 26

Lesion of PAPULAR URTICARIA

Answer 26

Initially an extremely itchy edematous papule followed by a firm pruritic papule 5hat persistent for several days

Question 27

Prurigo of Hebra is a

Answer 27

• Severe type of papular urticaria insect bite reaction in atopic patientsdue to environmentalfactors (poor nutritional and hygienic condition)

Question 28

TTT of Papular Urticaria

Answer 28

• Avoid insect bites and use insect repellant. • Topical corticosteroids. • Antihistamines. • Short-term oral steroids for extensive and spreading lesions. • Antibiotics in secondary infection. • Soothing lotion as calamine lotion or other topical antipruritic preparations. • Change of environment in severe cases (Prurigo of Hebra)

Question 29

Hallmark of the eruption in ERYTHEMA MULTIFORME

Answer 29

target or iris lesion ( circular erythematous leison with a vesicle or papule in center that is darker in color

Question 30

Most common cause of ERYTHEMA MULTIFORME

Answer 30

hypersensitivity reaction to Infection by herpes simplex

Question 31

Lesion of ERYTHEMA MULTIFORME

Answer 31

sudden onset of bilateral symmetrical multiform lesions including erythematous macules, papules, vesicles and sometimes bullae.

Question 32

Treatment of the ERYTHEMA MULTIFORME

Answer 32

• Symptomatic treatment is sufficient for the usual attack. • oral antihistamines reduce stinging & burning • Short-term oral steroids in moderate to severe cases. • In case of recurrent EM secondary to HSV: oral acyclovir at 10 mg/kg/d for 6-12 weeks may be considered as a prophylactic treatment.

Question 33

Lesion of Stevens Johnson Syndrome

Answer 33

Flu like symptoms followed by painful red or purplish rash blisters with shedding of top layers

Question 34

Eye affection in SJS

Answer 34

A severe catarrhal or purulent conjunctivitis. If 30% affected of body surface: Toxic epidermal necrosis

Question 35

Complications of Stevens Johnson Syndrome

Answer 35

Secondary skin infection(cellulitis) • Sepsis. • Eye problems extensive tissue damage and scarring up to blindness • Damage to internal organs as pneumonitis, myocarditis, nephritis and hepatitis. • Death may occur in 5-15% of untreated cases.

Question 36

Treatment of SJS

Answer 36

Admission to an intensive care unit Treatment of the cause and discontinuation of the offending drugs. Systemic steroidsIntravenous Immunoglobulins (IVIG)

Question 37

Etiology of ERYTHEMA NODOSUM

Answer 37

A type of hypersensitivity reaction to Streptococcal infection Tuberculosis. Sarcoidosis Chlamydia. Viruses as HBV Deep fungal infection. Sulphonamides and oral contraceptives. Ulcerative colitis. Malignancies Leprosy : erythema nodosum leprosum representing acute panniculitis of leprosy. Idiopathic

Question 38

Leison of ERYTHEMA NODOSUM

Answer 38

multiple bilateral, tender, warm, erythematous nodules (may be ecchymotic) mainly on the anterior aspects of the lower limbs.

Question 39

Treatment Of ERYTHEMA NODOSUM

Answer 39

• Rest in bed • Analgesics • Antibiotics • Acetyl salicylic acid • Systemic steroids in some cases • Treatment of the actual cause.

Question 40

Leison in Fixed Drug Eruption

Answer 40

eruption is sharply marginated rounded or oval erythematous patches which becomes dusky violaceous in color. Comments sites : Penis, lips, dorsum of hands Healing leaves permanent slate blue discoloration.

Question 41

Drugs causing FDE

Answer 41

sulfonamides and analgesics.

Question 42

The comments site of Infantile eczema

Answer 42

Face