Introduction to Erythemas, Urticaria and Skin Manifesations of Systemic Disease

Question 1

how does urticaria present?

Answer 1

wheal and angioedema of the swelling in deep dermis and subcutaneous

Question 2

main mediator of uriticaria

Answer 2

mast cell that release histamine, prostaglandins, leukotrienes

Question 3

uriticaria MOA

1. idiopathic immunologic
2. non-immunologic

Answer 3

1. idiopathic immunologic- ab against FceRI or IgE
2. non-immunologic- direct mast-cell releasing agents such as through vasoactive stimuli, aspirin and other non-steroidal anti-inflammatory drugs, and ACEi

Question 4

urticaria clinical types

1. acute
2. chronic

Answer 4

1. acute- <6 weeks and IgE process

2. chronic- >6 weeks and antiFceR ab

Question 5

cholinergic urticaria

Answer 5

papules and linear wheals happens from gym

Question 6

solar or cold urticaria

Answer 6

due to exposed areas

Question 7

urticarial vasculitis

Answer 7

wheals on lower extremity and it is pigmented. lesions last >24 hr

Question 8

treatment of urticaria (3)

Answer 8

1. remove offending agent
2. avoid offender
3. anti-histamines

Question 9

erythema multiforme

Answer 9

3 zones of color with the target papular lesions located usually symmetrically located on extremities and face

** not itchy but may have burning sensation

Question 10

erythema multiforme is primarly caused by infection of

Answer 10

HSV-1/2 and also thing of mycoplasama pneumoniae

Question 11

possible pathogenesis of erythema multiforme

Answer 11

circulating immune complexes

Question 12

treatment of erythema multiforme (3)

Answer 12

1. supportive
2. prednisone
3. treat precipitating infection

Question 13

stevens- johnson syndrome presentation

Answer 13

dusky or red dusky flat lesions with epidermal detachment found primarily in the face and trunk. it also has mucosal involvement

Question 14

toxic epidermal necrolysis

Answer 14

same presentation compared to stevens johnson syndrome but spectrum is based upon area of epidermal detachment

Question 15

triggers for stevens- johnson syndrome

Answer 15

1. sulfa/penicillin, Nsaids and anti-convulsants- those with a longer half life have a worse prognosis
2. infection
3. immunosupressive disease

Question 16

SJS/TEN death

Answer 16

1/3 due to its associated infections

Question 17

treatment for SJS/TEN (2)

Answer 17

1. steroids

2. high dose IVIG

Question 18

xanthoma presentation

Answer 18

collection of lipid-laden histiocytes in dermis or tendons and location is clue to etiology

***yellow

Question 19

kaposi’s sarcoma presentation

Answer 19

proliferation of endothelial cells that show up as purple macules/plaques/nodules on mucous membranes

Question 20

kaposi’s sarcoma 3 subtypes

Answer 20

1. classic- lower legs
2. AIDS associated
3. lymphadenopathic- disseminates rapidly seen in africa

Question 21

kaposi’s sarcoma clinical pearl

Answer 21

test for HIV

Question 22

erythema nodosum presentation

Answer 22

raised, tender re/violet subcutaneous nodules mainly found on shins

Question 23

causes of erythema nodosum

Answer 23

1. OCPs or pregnancy
2. strep. infection
3. inflammatory conditions such as sarcoidosis

Question 24

why should we check for antistreptolusin- o titer in EN?

Answer 24

check for strep infection

Question 25

acanthosis nigricans presentation

Answer 25

velvety hyperpigmented plaques/papules in intertriginous areas associated with insulin resistance/obesity/med and underlying malignancy

Question 26

malignancy associated with acanthosis nigricans

Answer 26

rapid onset and involvement of palms