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Ocular Disease > Midterm 2- allergic lid diease > Flashcards

Midterm 2- allergic lid diease Flashcards

1
Q

Type I rxn

A

immediate type reaction:
Reaction resulting from the release of pharmacologically active substances such as histamine, or eosinophillic chemotactic factor (ecf) from IgE-sensitized basophils and mast cells after contact with specific antigens
Occurs within minutes to hours

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2
Q

Type IV

A

delayed type reaction:
Reactions caused by sensitized lymphocytes (T-cells) after contact with antigens which result from direct cytotoxicity or from the release of lymphokines
Cell-mediated reaction
Occurs over hours to days

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3
Q

Dennie–Morgan fold (aka Dennie-Morgan line)

A

A fold or line in the skin below the lower eyelid caused by edema in allergic dermatitis

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4
Q

CONTACT DERMATITIS definiton

A

Very common immunological disease
Results from direct contact with environmental allergen

Episodes can be triggered by specific events

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5
Q

Dermatitis

A

any inflammation of the epidermis

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6
Q

Contact dermatitis

A

any skin inflammation that occurs when the skin surface comes in contact with a substance originating outside the body

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7
Q

Irritant Contact Dermatitis

A
  • More common
  • Contact with substance that directly damages skin
  • Nonspecific response of skin to chemical damage that releases mediators of inflammation from epidermal cells
  • Occurs within 1 – 24 hours; can occur within minutes
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8
Q

irritant contact dermatitis symptoms

A

Red rash with pain, burning, stinging, discomfort; maybe no itching
Often affects hands
Occupations: cleaning, hospital care, food prep, hairdressing

Soap and water, solvents, microtrauma, dry air, cleaners

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9
Q

irritant contact dermatitis diagnosis

A

Erythema- redness
Edema
Glazed, parched, scalded appearance
Skin usually dry with scaling
No diagnostic test
Patch test negative
Dx based on exclusion of other cutaneous diseases and clinical appearance of site exposed to a known irritant

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10
Q

irritant contact dermatitis tx

A
  • Avoid irritant via barriers
  • Non-sensitizing moisturizers
  • -Plain petroleum jelly
  • Mild skin cleansers
  • -Aquanil, Cetaphil cleanser, Neutrogena cleanser
  • Soaps with low irritant effect
  • -Dove, Cetaphil
  • Alcohol based hand cleansers with moisturizer
  • Avoid inappropriate solvents or abrasives to clean hands
  • No topical steroids!!!
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11
Q

Allergic Contact Dermatitis more tx

A

Occurs in sensitized individuals
Involves a cell mediated immunity response
Requires a latency period
The re-exposure precipitates the dermatitis
Response is usually in 48 hrs

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12
Q

Subjective

A

Hx is very important!

Red rash with ITCHING

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13
Q

possible allergens

A 
Plants (poison oak*, ivy)
Metals (nickel*, gold)
Hair products
Skin care products
Rubber/latex
Dyes
Chromates for leather tanning
Fragrances
Preservatives
Acrylates
Cosmetics
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14
Q

Topical ocular drugs allergies

A 
Antazoline
Neomycin
Phenylephrine
Atropine
Pilocarpine
Anti-glc drugs
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15
Q

allergic contact dermatitis objective

A

-Pruritis ( = itch!)
-Erythema
-Edema
-Chemosis of conjunctiva
-Vesicles
Weeping rash –> crusting, scaling –> darkened, cracked (fissured), leathery appearance
Keratitis may develop

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16
Q

allergic contact dermatitis dx

patch test

A

-Elicited from history

  • Patch skin tests
  • -Application of suspected materials to skin on patches
  • -Left on 48 hours, then read again between 72 hrs – 1 wk
  • -Positive: development of erythema, papules, edema, vesicles
  • -Correlation with history, location of eruption, clinical course to determine if true etiology

DDX from many similar appearing rashes

17
Q

allergic contact TX/Management

A

Remove allergen
Cold compresses 4 – 6X/day

Topical steroid ung or cream BID – TID for 5 – 10 days
< 1% hydrocortisone

Oral antihistamine
Diphenhydramine (Benadryl)

Ocular lubricants 4 – 6X/day for comfort or keratitis

Topical immunomodulator BID
Pimecromlimus (Elidel cream)
Tacrolimus (Protopic)

18
Q

ATOPIC DERMATITIS

A

Eczematous skin eruption AKA eczema

Onset in infancy: most common skin disease in children

Inherited condition
Usually in conjunction with other atopic conditions

INFLAMED PATCHES OF VERY ITCHY SKIN

19
Q

atopical dermatitus Clinical manifestations

A

Lesions vary with age

Early infancy:

  • Rash that is exudative, vesicular to maculopapular, see fine scales
  • Location often on face (cheeks common), scalp, knees in infants
  • ITCHING
20
Q

Atopic Dermatitis later stages

A

Dermatitis
Skin becomes dry and lichenified
Excoriated areas (abraded)
Pruritus ITCHING
Healing - hypo or hyper-pigmentation
Location most often seen on elbows, neck, back of knees, ankles in adults

21
Q

Atopic Dermatitis susceptibility

A
  • Patient is more prone to secondary infection due to Staphylococcus or Streptococcus
  • Unusual susceptibility to vaccinia, herpes simplex and molluscum contagiosum viruses

-Possible ocular manifestations of atopic dermatitis
Primarily lids

Clinical Course unpredictable, but usually subsides by age 3 or 4 with exacerbations and remissions frequently recurring throughout childhood, adolescence and adulthood

22
Q

Atopic Dermatitis symptoms

A 
ITCHY rash
Erythema
Edema
Exudative lesions
Xerosis 
Lichenfication
Excoriation and crusting
23
Q

atopical dermatitis dx

A

DX - tests not needed if condition presents with clear clinical markers
Patch test

24
Q

Nonmedical considerations:

A

Clothing
Cool temperature
Humidifier

25
Q

Nonmedical considerations:

A

Clothing
Cool temperature
Humidifier

26
Q

Urticaria

A

Urticaria = ITCHY WELTS = HIVES:
Cutaneous eruption

Multiple pathogenic mechanisms

May or may not be immunologic in origin

Only 70% have a specific identifiable cause

27
Q

Acute urticaria

A

– immunologic

28
Q

Chronic urticaria

A

– unknown

29
Q

Urticaria symptoms

A
  • 10 to 25% of the population
  • Intense pruritus

Raised wheals surrounded by erythematous flare
Size 1 to 5 mm to greater than 20 mm
Dilation and increased permeability of blood vessels in superficial dermis with edema in surrounding epidermis

May have a ring shape

May occur on any part of the body
May be transient in location

30
Q

ANGIOEDEMA:

A

WHEN THE INFLAMMATION INVOLVES DEEPER LAYERS OF SKIN

31
Q

angioedema symptoms

A
  • Skin appears normal
  • Dilation and increased permeability of blood vessels in the deep dermis with resulting edema of dermis
  • More extensive edematous areas
  • Little pruritus - sometimes described as painful or burning
  • Most often involves face, lips, eyelid, tongue, throat, hands, feet
  • May produce respiratory distress due to upper airway edema
32
Q

URTICARIA AND ANGIOEDEMA CAUSES

A

Drug reactions
Foods, food additives
Inhalant, ingested or contact antigens
Infections

Physical 
Cold
Heat
Exercise – induced
Solar
Water

Insect bites
Psychogenic
Systemic disease

33
Q

URTICARIA AND ANGIOEDEMA ddx

A

Need to be concerned that the edema is not caused by renal or cardiac disease
Contact dermatitis

34
Q

URTICARIA AND ANGIOEDEMA tx

A

Try to find the cause and avoid
Acute phase:
Cold compresses
Antihistamine
Systemic steroids - prednisone unpredictable
Epinephrine sc for acute pharyngeal or laryngeal angioedema

Ocular Disease (7 decks)

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