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Pediatrics > Allergic skin diseases > Flashcards

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
Q

Major criteria in AD

A
  • typical localization of skin lesioins
  • pruritus
  • chronic or relapsing course
  • personal history of allergy
  • family history of allergy
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26
Q

Minor cirteria in AD

A
  • 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
Q

White dermographism

A
  • due to an abnormal vascular response in patients with AD
28
Q

Pityriasis alba

A

stages:

  • slighly scaly pink plaque with just palpable papular surface
  • hypopigmented plaque with fine surface scale
  • post-inflammatory hypopigmented macule without scale
  • resolution
29
Q

Keratosis pilaris

A
  • 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
Q

Bacterial skin infection in atopic dermatiits

A
  • S.aureus

- -> impetigo bullosa or non-bullous impetigo

31
Q

Impetigo bullosa

A
  • 4th day from the beginning of rash

- 2nd day: T>39°

32
Q

Eczema herpeticum

A
  • 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
Q

SCORAD index

A

I Area - determine affected sites
II Objective assessment of skin lesions
III Assessment of subjective symtpoms (itch and sleeplessness)

34
Q

SCORAD I (A)

A

from 0 to 96 points (children under 2)

from 0 to 100 points (in children over 2)

35
Q

SCORAD II (B)

A

signs assessed are:

  • erythema
  • edema /papules
  • oozing/ crust
  • excoriation
  • lichenification
  • xerosis

intensity of ech sign is assessed from 0 to 3

36
Q

SCORAD III (C)

A
  • under 7 years old: parents should answer
  • symptoms during last 3 days
  • from 0 to 10 points each
37
Q

SCORAD index evaluation

A
  • 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
Q

General management of AD

A
  • 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
Q

wet wrap treatment in severe AD

A

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
Q

Allergen-specific immunotherapy (ASIT)

A
  • not recommended as a general treatment for AD
41
Q

Urticaria definition

A
  • skin disease characterized by pruritis transient (up to 24 hours) superficial swellings of skin –> wheals
  • angioedema
42
Q

Angioedema in urticaria

A
  • acute swelling of deeper skin layers, hypodermis
  • painful rather than itchy
  • often with swellign of mucosa
  • lasts longer (up to 72 horus)
43
Q

Classification of urticaria

A

CHRONIC SPONTANEOUS

INDUCIBLE

  • symptomatic dermographism
  • delayed pressure
  • solar urticaria
  • heat urticaria
  • vibratory angioedema
  • cholinergic urticaria
  • contact urticaria
  • aquagenic urticaria
44
Q

Pathophysiology of urticaria

A
  • 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
Q

Role of histamine

A
  • vasodilation and increased plasma extravasation
  • -> swelling of superficial-mid dermis -wheals
  • -> swelling of deep dermis –> angioedema
46
Q

Stages of urticarial reactions

A
  • Erythema: vasodilation
  • wheal: due to edema
  • Red flare around the whal: due to axon reflex
47
Q

Classification of urticaria based on duration

A
  • acute: under 6 weeks

- chronic: over 6 weeks, minimum 2 episodes per week

48
Q

Spontaneous uritcaria diagnosis

A
  • 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
Q

Cold urticaria

A
  • 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
Q

Cold uritcaria diagnosis

A
  • cold provocation test

- ESR, CRP, cryoglobulons

51
Q

Delayed pressure urticaria

A
  • type of dermographic urticaria

- deep and painful skin swelling after sustained pressure (after 1 hour)

52
Q

Delayed pressure urticaria diagnosis

A
  • pressure test (0.2-1.5 kg/cm2 or 10-20 min)
53
Q

Heat uritcaria diagnosis

A
  • heat provocation
54
Q

Solar urticaria diagnosis

A
  • UV and visible light of different wavelengths test
55
Q

Symtpomatic dermographism

A
  • rapidly occuring pruritic linear whealing after moderate scrathcing, stroking or rubbing
  • after wearing tight clothes
  • most common subtype of inducible ruticaria
56
Q

Symtpomatic dermographism diagnosis

A
  • elicit dermatographism

- ESR, CRP

57
Q

Aquagenic urticaria

A
  • after contact with water (shower, swimming)
58
Q

Aquagenic urticaria diagnosis

A

wet clothes at bod temperature appllied for 20 min

59
Q

Contact urticaria

A

after contact wiht allergen

60
Q

Cholinergic urticaria

A
  • small short-lived wheals
  • after exercising, perpiration
  • induced by an increase in the body core temperature, emotional distress
  • main mediator: acetylcholine
61
Q

Cholinergic urticaria diagnosis

A
  • exercise and hot bath provocation
62
Q

Contact urticaria diagnosis

A
  • skin prick/ skin patch test
63
Q

Assessming disease activity in urticaria

A

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
Q

Management of urticaria

A
  • 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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