Week 3 Acute Inflam. Dermatoses- Westra

Question 1

Identify

Answer 1

Urticaria

raised, erythemic, transient wheals

Any given wheals persist for < 24 hours

IgE and histamine mediated

PRURITIC

Question 2

Identify

Answer 2

Angioadema

deep dermal subuctaneous swelling

burning/ PAINFUL

laryngeal involvement = emergency

intese swelling of the dermis

Common on lips, eyes, groin, palm/soles

Question 3

Identify

Answer 3

Cholinergic Urticaria

1-3 papules on a red flare

sweating vs. heat

small papular urticarial after exercies, sweating, or hot showers

Question 4

Identify

Answer 4

cold urticaria

Hives begin during the cold exposure but are maximal upon re-warming

Question 5

Identify

Answer 5

dermographism (friction urticaria)

Question 6

Identify

Answer 6

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

Question 7

Identify

Answer 7

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**

Question 8

Identify

Answer 8

SJS secondary to sulfa

Question 9

Identify

Answer 9

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

Question 10

Identify

Answer 10

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

Question 11

Identify

Answer 11

erythema nodosum

Erythematous tender nodules on anterior shins

Young women most common

Treatment: rest, ice, and pain control

Question 12

Identify

Answer 12

erythema induratum

Tender red nodules usually on posterior legs

Chronic, recurrent subcutaneous nodules and plaques with ulceration

middle ages females

Associated with TB

Question 13

What may cause urticaria/angioedema?

Answer 13

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)

Question 14

What is the hallmark treatment for acute uritcaria?

Answer 14

ANTIHISTAMINES!

Question 15

How do you manage chronic urticaria?

Answer 15

Antihistamines!

First choice= second generation, non-sedating H1-blockers

(Last option is prednisone)

Question 16

Erythema mulitform:

Minor vs. Major

Answer 16

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

Question 17

How do you differentiate Erythema multiforme from urticaria?

Answer 17

EM is usually fixed and does not itch

Question 18

Erythema Multiform (Mildest)

Steven’s Johnson Syndrome (consdiered maximal varient of EM major)

SJS/TEN overlap

Toxic Epidermal Necryolysis (TEN) (Worst)