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Derm Rheum > Urticaria and Drug Rashes - Schwarzenberger > Flashcards

Urticaria and Drug Rashes - Schwarzenberger Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe the pathophysiology of urticaria

A

An inflammatory skin reaction caused by the release of histamine/other cytokines

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2
Q

Are all cases of urticaria allergen associated?

A

No, allergic or non-allergic

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3
Q

Timeframe of urticaria? Why is this important?

A

Each individual urticaria wheal will last no longer than 24 hours; if a single wheal lasts longer, reconsider the dx

(but whole episode can last longer)

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4
Q

What is angioedema in the context of urticaria? how long does it last?

A

swelling of the deeper dermis and subQ tissue; up to 72 hours

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5
Q

Drugs that commonly cause acute urticaria?

A

B-lactam abx, NSAIDs, ASA, opiates, IV radiocontrast

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6
Q

What cause of acute urticaria is seen in children frequently, but not in adults?

A

Food allergen induced

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7
Q

Differentiation between acute urticaria vs. chronic urticaria (how long does each last?)

A

Acute–> less than 6 weeks Chronic–> more than 6 weeks

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8
Q

Disease associated with chronic urticaria (I know it’s vague, she threw this out in class though)

A

Hashimoto’s Thyroiditis

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9
Q

Common locations of angioedema?

A

Lips, periorbital areas, hands, and feet

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10
Q

Why can ACE inhibitors cause angioedema?

A

Angiotensin converting enzyme normally breaks down Bradykinin

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11
Q

Hereditary angioedema cause (Angelina Jolie syndrome)?

(Angiolina Joliedema)

A

C1 inhibitor deficiency

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12
Q

Hoarseness in a patient in with angioedema. What are you worried about?

A

airway compromise

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13
Q

What is dermatographism?

A

condition of mast cell degranulation upon pressure application

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14
Q

What non immunologic things can cause urticaria?

A

Cold, heat, pressure, solar exposure, water

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15
Q

Primary therapy in uritcaria?

A

2nd generation anti-histamines

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16
Q

Why do you NOT use systemic glucocorticoids in urticaria?

A

risk of rebound urticaria

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17
Q

What is the most common cause of acute urticaria (hint: it’s not drug related)?

A

Viral infection

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18
Q

What do you assume as diagnosis when you see urticaria +24 hours (INDIVIDUAL lesions past 24 hours) ? What must you do at this point?

A

Assume urticarial vasculitis; biopsy the lesion

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19
Q

Risk factors for developing a cutaneous Rx rash?

A

Increased age, female gender, concomitant viral infection (HIV/EBV)

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20
Q

Most common drugs that cause cutaneous Rx induced rash (there’s 3)?

A

Abx, anticonvulsants, NSAIDs

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21
Q

Misdiagnose a patient with a bacterial infection and give them an abx. They break out with acute urticaria. What do you assume the correct diagnosis to be?

A

EBV infection; this precipitated the cutaneous abx rash

22
Q

List the 5 types of cutaneous drug reactions discussed in the lecture? Frequency of 2 she mentioned?

A
  • Morbilliform “maculopapular” rash - 90%
  • Urticarial rash - 5%
  • DRESS (Drug rash w/ eosinophilia and systemic symptoms
  • Fixed Drug reaction
  • Stevens-Johnson Syndrome/Toxic epidermal necrolysis
23
Q

Most common distribution of cutaneous Rx rash?

A

90% are morbilliform (maculopapular)

24
Q

Describe a mobilliform rash

A

Multiple small, pink, itchy papules on the trunk or pressure bearing areas (especially back/shoulders); spreads out over time to become confluent

25
Q

How long does a morbilliform Rx rash take to form? What type of reaction?

A

5-7 days; it’s a Type IV cell mediated hypersensitivity

26
Q

Course of morbilliform Rx rash?

A

Almost all resolve spontaneously in 1-2 weeks

27
Q

Most common causes of MORBILLIFORM drug reactions?

A

PCNs, Cephalosporins, Sulfonamides, anticonvulsants

28
Q

How long does a urticarial Rx drug reaction take to form? what type of reaction?

A

minutes of exposure; it’s a Type I (IgE mediated) hypersensitivity

29
Q

Most common causes of acute URTICARIAL Rx reactions?

A

PCNs, cephalosporins, ASA, latex (omar)

30
Q

What must have happened previously for an acute URTICARIAL rash to be possible?

A

Prior exposure and sensitization to that antigen

31
Q

What else is Drug rash with eosinophilia and systemic symptoms (DRESS) known as?

A

Drug hypersensitivity syndrome

32
Q

Describe the presentation seen in DRESS

A

Severe morbilliform reaction with eosinophilia and systemic illness

33
Q

Onset of DRESS?

A

2-6 weeks post exposure

34
Q

Systemic symptoms of DRESS?

A

Fever, joint pain, LAD

35
Q

Visceral involvement in DRESS?

A

multisystem, liver commonly affected

36
Q

Drugs commonly causing DRESS?

A

anticonvulsants (Carbamazepine most common), Allopurinol (also very common), sulfonamides, minocycline, erthyromycin

37
Q

Treatment of DRESS?

A

long term therapy with systemic corticosteroids

38
Q

Is DRESS fatal?

A

Yes, 10% due to severe hepatic failure

39
Q

Describe the lesion seen in a fixed drug eruption

A

A well circumscribed, red-brown plaque; may blister; reaction occurs in the exact same place if patient is re exposed

40
Q

How does a fixed drug eruption appear when it heals?

A

hyper-pigmented

41
Q

Most common areas for a fixed drug eruption

A

Genitals, lips, extremities

42
Q

Common causes of fixed drug eruption

A

sulfonamides, NSAIDs, poopoo powder (laxatives)

43
Q

What is Stevens-Johnson Syndrome/Toxic epidermal necrolysis?

A

Potentially life threatening spectrum of blistering skin disease

44
Q

Most common cause of SJS/TEN (think very generally)?

A

Drugs (almost all are drug related)

45
Q

Most common drugs causing SJS/TEN?

A

Abx, anticonvulsants, allopurinol, NSAIDs, Nevirapine, Abacavir, Acetaminophen (children)

46
Q

What do you need to make an official diagnosis of SJS/TEN (physical exam findings)?

A

Skin AND oral mucosal involvement

47
Q

Describe the presentation/onset of SJS/TEN

A

Onsets 1-2 months post exposure; begins influenza like (SORE THROAT, myalgias, fever); skin develops DUSKY TARGET LESIONS (buzz word); patients will present saying “THEIR SKIN HURTS”

48
Q

What does SJS/TEN look like on histologic examination?

A

A very clean split between the epidermis and dermis; not much inflammation at the separation site

49
Q

Tx for SJS/TEN?

A

STOP THE OFFENDING AGENT; supportive care in a burn unit with aggressive wound care; DO NOT give prophylactic abx

50
Q

Why do you NOT give corticosteroids to SJS/TEN patients?

A

Increases mortality; development of infection from immunosuppression

51
Q

What do patients with SJS/TEN die of, if they pass?

A

Sepsis

Derm Rheum (39 decks)

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