Urticaria, pruritis and eczema Flashcards
URTICARIA OVERVIEW
i) how is it characterised? what is a wheal?
ii) what is classed as acute or chronic?
iii) what is the most common cause in children? what can cause it in older children? (2)
iv) what is the appearance of urticarial wheals? where does it affect?
v) what is angioedema? how is it different to urticarial wheals
i) charac by very itchy wheals (hives) with out without surrounding erythematous flares
wheal - superficial skin coloured or pale skin swelling surrounded by erythema that lasts from mins to 24hrs
ii) acute - <6 weeks duration - often gone within hrs to days
chronic - >6weeks wtih daily or episodic wheals (chronic can be spontaneous or inducible)
iii) children - usually caused by infection
older children - inhaled allergens, food and medication
iv) few mm to several cm coloured white or red with or without a red flare > can affect any site and are usually distrib widely
v) angioedema = deeper swelling in skin or mucus membranes - often more localised and affects eyelids, hands, feet and genitalia
URTICARIA ASSESSMENT AND DX
i) what can be used to record and compare degree of itch in chronic spontaneous urticaria? what can be used to assess QOL?
ii) what is defined to diagnose urticaria? what may requested if drug/latex or food allergy is suspected to be the cause in acute urticaria
iii) how is inducible urticaria confirmed?
i) use of a visual analogue scale - UAs& scoring system
use DLQI to assess QOL
ii) history of wheals that last less than 24hours with or without angioedema
do skin prick test/RAST or CAP fluoroimmunoassay if suspected to be drug etc induced
iii) induce the reaction with agent or applying ice cube is suspected cold urticaria
URTICARIA TREATMENT
i) what is the main treatment for adults and children? give an example
ii) what type of allergens should be avoided in order to clear urticaria?
iii) name three types of drug that should be avoided
iv) what other drug may be used in severe acute urticaria? what should be given if life threatening?
i) oral second generation H1 antihistamines such as cetrizine or loratidine
ii) avoid type I IgE mediated antigens
iii) avoid aspirin, opiates and NSAIDs
iv) severe - can use 4-5 day cause of oral prednisolone
life threat - IM adrenaline
PRURITIS
i) what is it? name two things it can lead to over a period of time
ii) name four possible underlyign causes that need to be investigated for
iii) what is first done for diagnosis?
iv) name three topical tx that can be given
v) name three systemic therapies that can be given? name another type of therapy that can be given
i) itch - unpleasant senstation on skin that cause itch/rub to relieve it
- can lead to lichenification (thickened skin) and prurigo papules and nodules
ii) renal or liver failure, thyroid abnormalities, calcium abnormalities, blood cell dyscrasia, malignancy
iii) history and exam - look for underlying derm causes eg scabies, lichen simplex
no primary skin lesions - look for systemic/neuropathic psychogenic causes
iv) wet dressings, calamine lotion, menthol lotion, local anaes, emollients, mild topical steroids for short perod of time
v) anti histamines, tricyclic antideps, tetracyc antideps eg mirtazipine, anti epileptics eg valproate and gabapentin, aspirin
- can also give photo therapy - UVB
- or behavioural therapy
ATOPIC ECZEMA
i) what is it? name two scoring systems
ii) which areas are most affected in non mobile infants? which areas in a crawling infant?
iii) what is seen on the skin? (2)
iv) name four potential triggers
i) itchy skin condition in the last 12 months
- score with EASI or CDQLI (QOL)
ii) non mobile - cheek/face/scalp
crawling infant - extensor surfaces eg knees
older - flexures eg elbow
iii) see follicular (dots), lichenification (thick skin), discoid (itchy raised plaques)
iv) triggers - temperature, heat, humidity, soap, clothes, stress, teething
ALLERGENS IN ECZEMA
i) what test should be done if food is though to be the trigger? name two common culprits?
ii) name three other culprits
iii) ideally how long should breastfeeding continue to prevent atopic ecz, cows milk allergy, wheezing? can allergens pass through breast milk?
i) do allergen specific IgE or skin prick test (better)
common culprits are eggs and dairy
ii) animal fur, wool, house dust mite
iii) 4 months, ideally 6
allergens can pass through breast milk so if baby is allergic then mum must avoid also
COWS MILK ALLERGY
i) what diet helps this improve? what MDT member needs to be involved?
ii) what are the two mechanisms of food allergy
i) improve with dairy free diet but need dietician involvement and a correct alternative milk subsitute
ii) immediate eg IgE or delayed
TREATMENT FOR ATOPIC ECZEMA
i) name two treatments for mild disease? name two topical immunomodulators
ii) name two things that can be given in severe disease
iii) name three components of education for patients
i) emollients and bath oils
topical immod - steroids or calceneurin inhibitors eg tacrolimus (protopic)
ii) severe - phototherapy or systemic immunomodulators
iii) teach children how to recognise flares (Inc dryness, itching, redness), teach about triggers (irritant and infections), teach how to recog infection
TYPES OF TREATMENT FOR ATOPIC ECZEMA
i) what are emollients used for? how much should be applied? should they be stopped with eczema clears? what should it be used as a substitute for? what can it be used instead of in children under 1yr
ii) how often should topical steroids be used? how long after symptoms subside should it be continued? name a weak and a strong one? what is the max strongest that should be used on the face?
iii) name two calceneurin inhibitors? when should they be used? under what age are they not licensed for?
i) used for moisturising, washing and bathing - use in large amounts, frequently
use every day even when ecz is clear
use as a soap subsitute and can be used instead of shampoo for children under 1yr
ii) use once or twice daily - cotinue for 48hrs after symptoms subside
hydrocortisone/modrasone weak and elocon, dermovate strong (only use once per day)
modrasone is strongest that should be used on the face
iii) tacrolimus, pimecrolimus - use if topical steroids are ineffective or vulnerable sites eg face
no licensed under 2yrs
IMPETIGO
i) what type of infection is it? name two common causatives?
ii) name three things that may be seen? what investigation should be done?
iii) name an antibiotic that may be given? what can be given if there is recurrently infected ezcema?
i) bacterial infection - contagious caused by staph aureus or strep pyogenes
ii) charac by pustules and honey coloured crusted erosions - do a swab
iii) give topical or PO abx eg fluclox or antiseptics for recurrently infected eczema
ECZEMA HERPETICUM
i) what is it? how is it characterised? (2)
ii) what causes most cases? how quickly do signs appear?
iii) which treatment should be stopped? what treatment should be started?
iv) what referral should be done if there is periorbital disease
v) which areas does it most commonly affect? what systemic features are seen
i) disseiminated viral infection charac by fever and clusters of itchy blisters or punched out erosions
ii) HSV 1 or 2 - signs appear 5-12 days after contact with infected individual
iii) stop topical steroids and start aciclovir
iv) opthalmology opinion if periorbital disease
v) usually affects face and neck - see fever and swollen LNs as well as blisters, crust
SEBORRHOEIC ECZEMA OR ATOPIC EZCEMA?
i) which one has an earlier onset?
ii) which was has the most intense inflammation?
iii) which one has pruritis, irritability and sleeplessness
iv) in which one do infants usually feed well?
v) which can be treated with emollients and a mild steroid?
i) seb
ii) atopic
iii) atopic
iv) seb
v) seb
