Week 3 Acute Inflam. Dermatoses- Westra Flashcards
Identify
Urticaria
raised, erythemic, transient wheals
Any given wheals persist for < 24 hours
IgE and histamine mediated
PRURITIC
Identify
Angioadema
deep dermal subuctaneous swelling
burning/ PAINFUL
laryngeal involvement = emergency
intese swelling of the dermis
Common on lips, eyes, groin, palm/soles
Identify
Cholinergic Urticaria
1-3 papules on a red flare
sweating vs. heat
small papular urticarial after exercies, sweating, or hot showers
Identify
cold urticaria
Hives begin during the cold exposure but are maximal upon re-warming
Identify
dermographism (friction urticaria)
Identify
Erythema Multiforme
erythematous iris-shaped papular and veisculobullous lesion
Acute hypersensitivity reaction showing classic “target” lesions
involves extremities (especially palms and soles)
Usually males under age 20
Could be caused by drugs, infection, or idiopathic
Identify
Steven Johnson Syndrome
Skin tenderness and erythema of skin and muscosa
Followed by extensive cutaneous and mucosa epidermal necrosis and sloughing
potentially life threatening
**Need to watch for secondary infection and fluid and electrolyte loss**
Identify
SJS secondary to sulfa
Identify
Toxic epidermal necrolysis (TEN)
Unclear whether TEN is a severe form of erythema multiforme or a distinct disease
TEN is a medical emergency on the order of total body 2 degree burn (becuase there is total detachment of the epidermis)
Begins hours to days of exposure (up to 2 weeks)
Fever, malaise, arthralgias
Treatment: Early Diagnosis and withdrawl of drug
Identify
fixed drug erruption
localized, sharply demarcated erythematous patch that can itch, burn or be asymptomatic
Mostly on face and genitals
Often heals as hyper pigmented area, and will recur in the same place if rechallenged
Treatment: eliminate offending drug
Identify
erythema nodosum
Erythematous tender nodules on anterior shins
Young women most common
Treatment: rest, ice, and pain control
Identify
erythema induratum
Tender red nodules usually on posterior legs
Chronic, recurrent subcutaneous nodules and plaques with ulceration
middle ages females
Associated with TB
What may cause urticaria/angioedema?
Immune causes:
Type 1 IgE mediated- fish, peanuts, eggs, milk, soy, latex, bees, drugs, molds
Autoimmune
infections- viral, parasitic, fungal or bacterial
Non immune causes physical urticarias:
Solar (sun)
Cholinergic (sweating vs. heat)
Cold urticarial
Dermographism (friction)
Virbratory angioedema
Pressure urticarial (burning hands, feet, butt)
OR
Direct mast-cell degranulation (mostly by drugs)
foods containing high levels of histamine (strawberries, tomatoes, shrimp, lobester, cheese, spinach)
What is the hallmark treatment for acute uritcaria?
ANTIHISTAMINES!
How do you manage chronic urticaria?
Antihistamines!
First choice= second generation, non-sedating H1-blockers
(Last option is prednisone)
Erythema mulitform:
Minor vs. Major
Minor form involves 1 or less mucousal sites (major cause is poster herpes simplex infection, rash onset at day 10)
Major= severe with extensive skin ad mucous membrane involvement (Stevens-Johnson sydrome) usually due to drugs, and after a mycoplasma peumoniae infection
How do you differentiate Erythema multiforme from urticaria?
EM is usually fixed and does not itch
Erythema Multiform (Mildest)
Steven’s Johnson Syndrome (consdiered maximal varient of EM major)
SJS/TEN overlap
Toxic Epidermal Necryolysis (TEN) (Worst)
