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Allergic skin diseases Flashcards

1
Q

Allergic contact dermatitis definition

A
  • inflammatory skin disease caused by a delayed-type hypersensitivity reaction to material (the allergen) in contact with the skin
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2
Q

Irritant contact dermatitis definition

A

inflammation of the skin caused by contact with irritant materials, environmental factors (no immunological mechanism involved)

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3
Q

Photodermatitis definition

A

dermatitis caused by UV rays and delayed-type hypersensitivity reaction (photoallergic) or toxic damage of an epidermis (phototoxic)

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4
Q

Photodermatitis clinical manifestation

A
  • burning
  • itching
  • stinging
  • large blisters

caused by contact with the photosensitizing compounds found naturally in some plants and vegtables like parsley, citrus fruits, carrots

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5
Q

Allergic contact dermatitis can occur from…

A

2-3 years (rarely in infancy)

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6
Q

The most common contact allergens among children

A
  • nickel
  • chrome (is used in tanning)
  • Cobalt
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7
Q

Acute Contact Dermatitis presentation

A
  • clearly defined erythema, edema
  • papules, vesicles
  • oozing, crusts
  • scaling
  • itchign, burning
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8
Q

Chronic contact dermatitis presentation

A
  • slght erythema
  • scaling
  • hyperpigmentation
  • lichenification
  • erosions
  • itching
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9
Q

Diagnosis of allergic CD

A
  • history and clinical presentation

- skin patch testing

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10
Q

Diaper dermatitis

A
  • usually irritant CD
  • may be allergic in these cases
  • -> disperse dyes
  • -> emulsifier
  • -> rubber products
  • -> fragnances
  • -> preservatives (in wipes)
  • -> resin (glue)
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11
Q

Dimethyl-glyoxime test

A

Nickel spot test

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12
Q

Natural remedies for CD

A
  • balsam of peru (from myroxylon pereira)

- essential oils –> tea tree oil, lemon oil, eucalyptus oil

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13
Q

Tattoos

A
  • in black henna: p-phenylenediamine (PDD)
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14
Q

Acute contact dermatitis management

A
  • avoidance of allergens or irritant substances
  • treatment of skin inflammation (local CCS, systemic CCs for severe cases)
  • sensitive skin topical calcineurin inhibitors
  • improvvement of skin’s barrier function (emollient)
  • orevention if infections and treatment
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15
Q

Atopy

A
  • genetic tendency to produce specific immunoglobulin E to small doses of environmental allergens

atopic diseases

  • atopic dermatitis
  • allergic bronchial asthma
  • allergic rhinoconjunctivitis
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16
Q

Atopic dermatitis is characterized by:

A
  • intensive pruritus
  • typical symmetrical skin rash
  • relapsing course
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17
Q

Endogenic causes of atopic dermatitis

A
  • genetically impaired skin barrier function with increased transepidermal water loss (filaggrin deficiency)
  • filaggrin is a protein that binds keratin fibers in epithelial cells
  • individuals with mutations in the gene for filaggrin are predisposed to a severe form of dry skin, ichtyosis vulgaris and eczema
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18
Q

Pathophysiology of atopic dermatitis

A
  • immune deviation towards the Th2 pathway in the initiation phase with consequent increased IgE production
  • increased production of mediators from various inflammatory cells
  • deficient skin barrier function due to abnormal lipid metabilism and epidermal structural protein formation of filaggrin and protease inhibitors
  • an abnormal micorbial colonization with pathogenic organisms such as S. aureus and increased susceptibility to skin infection
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19
Q

Etiology of atopic dermatitis

A
  • environmental allergens
  • food allergens
  • infections
  • hormones
  • climate
  • season
  • stress
  • skin irritants
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20
Q

Fungal infections

A
  • yeast malassezia or pityrosporum
  • can be a trigger in AD
  • patients with head-and-neck dermatitis
  • antimycotic therapy can help (2-3 months of itraconazole or ketoconazole)
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21
Q

Infantile atopic dermatitis clinical manifestations

A
  • face, neck, chest, scalp, extensor surfaces, flexor surfaces
  • “wet eczema”: pruritic, red, scaly and crusted lesions
  • acute lesions include vesicles, and there can be serous exudates and crusting in severe cases
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22
Q

Childhoof atopic dermatitis clinical manifestations

A
  • neck, flexor surfaces: antecubital and popliteal fossa, wrists, ankles, periorbital erythema, eyelids, nipple area, lips
  • “dry eczema”: symmetrical erythemic lichenified plaques, excoriation, scaling
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23
Q

Adolescent atopic dermatitis

A
  • hyperlinear palms
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24
Q

Atopic dermatitis diagnosis

A
  • anamnesis
  • clinical signs
  • lab. testing: blood test, IgE
  • allergological examination:
  • -> skin prick test, prick-to-ptick test
  • -> skin patch test
  • -> oral food challenge
  • 3 major and 3 minor criteria
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25
Major criteria in AD
- typical localization of skin lesioins - pruritus - chronic or relapsing course - personal history of allergy - family history of allergy
26
Minor cirteria in AD
- dry skin - early age of onset - cheilitis - hyperlinear palms - elevated serum IgE - susceptibility to cutaneous infections - course influenced by environment - recurrent conjunctivitis - white dermographism - infraorbital folds - pityriasis alba - keratosis pilaris
27
White dermographism
- due to an abnormal vascular response in patients with AD
28
Pityriasis alba
stages: - slighly scaly pink plaque with just palpable papular surface - hypopigmented plaque with fine surface scale - post-inflammatory hypopigmented macule without scale - resolution
29
Keratosis pilaris
- common in children with AD - autosomal dominant inheritance - more prominent in winter - due to abnormal keratinization of the linign of the upper portion of the hair follice - both upper arms, thighs, buttocks and sides of the cheeks
30
Bacterial skin infection in atopic dermatiits
- S.aureus | - -> impetigo bullosa or non-bullous impetigo
31
Impetigo bullosa
- 4th day from the beginning of rash | - 2nd day: T>39°
32
Eczema herpeticum
- multiple umbilicated vesiculopustules - mostly head, neck, trunk - rapildy worsening, painful lesions - possible fever, malaise, lymphadenopathy - prone to secondary bacterial infection - life-threatening dissemination - heal within 2-6 weeks
33
SCORAD index
I Area - determine affected sites II Objective assessment of skin lesions III Assessment of subjective symtpoms (itch and sleeplessness)
34
SCORAD I (A)
from 0 to 96 points (children under 2) from 0 to 100 points (in children over 2)
35
SCORAD II (B)
signs assessed are: - erythema - edema /papules - oozing/ crust - excoriation - lichenification - xerosis intensity of ech sign is assessed from 0 to 3
36
SCORAD III (C)
- under 7 years old: parents should answer - symptoms during last 3 days - from 0 to 10 points each
37
SCORAD index evaluation
- using formula A/5 + 7 x B/2 + C 1-24 points: mild AD 25-50 pints: moderate AD - over 50 points: severe AD
38
General management of AD
- avoidance of allergens and exacerbating factors - skin care, emollients - bath and bath oils for avoiding epidermal dehydration - antiseptics and antimicrobial agents (against S.aureus) - topical CCS or calcineurin inhibtors - antihistamines (systemic)
39
wet wrap treatment in severe AD
two layers fo dressing - moist dressing which is saturated with emdicaments directly on skin - ovelying dry dressing - cooling, anti-inflammatory and anti-pruritic effect
40
Allergen-specific immunotherapy (ASIT)
- not recommended as a general treatment for AD
41
Urticaria definition
- skin disease characterized by pruritis transient (up to 24 hours) superficial swellings of skin --> wheals - angioedema
42
Angioedema in urticaria
- acute swelling of deeper skin layers, hypodermis - painful rather than itchy - often with swellign of mucosa - lasts longer (up to 72 horus)
43
Classification of urticaria
CHRONIC SPONTANEOUS INDUCIBLE - symptomatic dermographism - delayed pressure - solar urticaria - heat urticaria - vibratory angioedema - cholinergic urticaria - contact urticaria - aquagenic urticaria
44
Pathophysiology of urticaria
- mast cell degranulation adn liberation of histamine - -> type I hyerpsensitivity reactions --> allergic urticaria - .> Autoantibodies agains FcRI receptors or IgE --> autoimmune ruticaria - -> Stimulation of nervous system: cholinergic urticaria - -> direct liberation of histamine: contat urticaria
45
Role of histamine
- vasodilation and increased plasma extravasation - -> swelling of superficial-mid dermis -wheals - -> swelling of deep dermis --> angioedema
46
Stages of urticarial reactions
- Erythema: vasodilation - wheal: due to edema - Red flare around the whal: due to axon reflex
47
Classification of urticaria based on duration
- acute: under 6 weeks | - chronic: over 6 weeks, minimum 2 episodes per week
48
Spontaneous uritcaria diagnosis
- acute: diagnostic tests not recommended - chronic: blood test, ESR, CRP, omission of suspected drugs test for infectious diseases, allergy, Abs, thyroid hormones, phyiscal tests...
49
Cold urticaria
- after contact with cold or mosit air, after cold shower - on not clothed skin sites - patients may experience syncope due to generalized urticaria (in the sea) - usually patients have other chronic diseases
50
Cold uritcaria diagnosis
- cold provocation test | - ESR, CRP, cryoglobulons
51
Delayed pressure urticaria
- type of dermographic urticaria | - deep and painful skin swelling after sustained pressure (after 1 hour)
52
Delayed pressure urticaria diagnosis
- pressure test (0.2-1.5 kg/cm2 or 10-20 min)
53
Heat uritcaria diagnosis
- heat provocation
54
Solar urticaria diagnosis
- UV and visible light of different wavelengths test
55
Symtpomatic dermographism
- rapidly occuring pruritic linear whealing after moderate scrathcing, stroking or rubbing - after wearing tight clothes - most common subtype of inducible ruticaria
56
Symtpomatic dermographism diagnosis
- elicit dermatographism | - ESR, CRP
57
Aquagenic urticaria
- after contact with water (shower, swimming)
58
Aquagenic urticaria diagnosis
wet clothes at bod temperature appllied for 20 min
59
Contact urticaria
after contact wiht allergen
60
Cholinergic urticaria
- small short-lived wheals - after exercising, perpiration - induced by an increase in the body core temperature, emotional distress - main mediator: acetylcholine
61
Cholinergic urticaria diagnosis
- exercise and hot bath provocation
62
Contact urticaria diagnosis
- skin prick/ skin patch test
63
Assessming disease activity in urticaria
from 0 to 3 points WHEALS 0: none 1: mild (under 20 per 24h) 2: moderate (20-50 in 24h) 3: intense (over 50 in 24 h) PRURITUS 0: non 1: mild 2: moderate 3: intense
64
Management of urticaria
- first line: modern second generation antihistamines if symtpoms persist after 2 weeks: - second line: increased dosage up to fourfold of moder second generation antihistamines if symptoms persist after 1-4 further weeks - third line: add on to second line omalizumab or Cyclosporin A or Montelukast - short couse (max 10 days) of CCS may also be used

Pediatrics (11 decks)

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