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Dermatology 2 > Urticaria & Angioedema > Flashcards

Urticaria & Angioedema Flashcards

1
Q

urticaria is characterized by . . .

A

rapid onset of lesions called wheals

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2
Q

wheal

A
  • central mid-dermal swelling w/ or w/o surrounding erythema w/ associated pruritus
  • lasts from 30 min. - 24 hrs
  • they blanch
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3
Q

angioedema

A
  • deeper swelling (dermis and SQ tissue) w/i skin or mucous membranes
  • ill defined
  • lasts up to 72 hrs
  • may be itchy, painful, or asx
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4
Q

areas commonly affected by angioedema

A
  • face (eyelids and perioral sites)
  • hands
  • feet
  • genitalia
  • tongue, uvula, soft palate, larynx
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5
Q

respiratory involvement of angioedema

A

-may target GI and/or resp. tract causing abd pain, coryza, asthma, obstruction, anaphylaxis and hypotension

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6
Q

2 subsets of angioedema

A
  • deep urticaria w/ or w/o hives

- hereditary / ACE inhibitor associated

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7
Q

deep urticaria w/ or w/o hives

A
  • angioedema d/t the reaction of histamine release

- pruritis may be significant feature

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8
Q

hereditary / ACE inhibitor associated angioedema

A
  • hereditary: associated w/ acquired C1 esterase inhibitor deficiency
  • not pruritic and no hives
  • pain sx are predominant
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9
Q

duration of urticaria: chronic vs. acute

A
  • acute urticaria: < 6 weeks

- chronic urticaria: > 6 weeks

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10
Q

pathophys of urticaria

A

-mast cell degranulation w/ release of histamine

w/ ACE associated and hereditary the mediator is bradykinin

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11
Q

what kinds of stimuli can lead to mast cell activation?

A
  • infections
  • drugs
  • foods
  • inhalants
  • emotional stress
  • systemic dz
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12
Q

what major systemics diseases can lead to mast cell activation?

A
  • lupus erythematosus

- thyroid disease

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13
Q

MC causes of acute urticaria

A
  • infections

- adverse reactions to medications

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14
Q

Chronic urticaria

A
  • F>M
  • idiopathic > autoimmune
  • hives can stick around from weeks to years
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15
Q

physical urticaria

A
  • a form of chronic urticaria
  • MC in ages 17-40
  • caused by a physical stimulus leading to mast cell degranulation
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16
Q

dermatographism

A
  • shearing forces on skin

- may present as urticarial lesions at site of scratching

17
Q

cold urticaria

A
  • sudden exposure to cold incites stimulus

- occurs during rewarming

18
Q

delayed pressure urticaria

A
  • 4-6 hr after prolonged pressure

- MC on palms and soles

19
Q

heat urticaria

A

direct contact w/ a warm object incites stimulus

20
Q

cholinergic urticaria

A

-rise in core body temp secondary to exercise, hot water, or stress

21
Q

contact urticaria

A

contact w/ chemicals found in food, plants, medicines

22
Q

solar urticaria

A

UV or visible light

23
Q

aquagenic urticaria

A
  • very rare

- caused by contact w/ water of any temp.

24
Q

what to r/o for urticaria

A
  • urticarial vasculitis
  • bullous pemphigoid
  • urticaria pigmentosa
  • papular urticaria (bug bites)
25
Q

urticarial vasculitis

A
  • causes persistent urticaria-like plaques that lasts> 24 hrs and resolve w/ bruising, non-blanching
  • painful > itchy
  • bx to differentiate
26
Q

urticaria pigmentosa

A
  • localized tan “mole” that swells and itches when stimulated
  • doesn’t move
27
Q

presentation of papular urticaria aka bug bites

A
  • grouped or linear

- in a “breakfast, lunch, dinner” pattern

28
Q

clinical steps if urticaria is acute and recurrent

A
  • consider food diary

- order RAST to detect specific IgE

29
Q

clinical evaluation of angioedema in absence of urticaria

A

-measure C4/C1-esterase inhibitor b/c it’s likely CI esterase def., hereditary or ACE-I

30
Q

clinical eval in chronic urticaria

A
  • ask about: thyroid dz, CTD, infection, jaundice, hepatitis, Lyme, sinus, strep, UA, dental films
  • order: CBC w/ diff, CMP, ANA, TSH, thyroid ABs, hepatitis panel
31
Q

what is the mainstay of tx for acute urticaria?

A
  • antihistamines:
  • 2nd generation are non drowsy
  • 1st gen cross the BBB and cause drowsiness
  • use until sx are controlled then 4-6 weeks more
32
Q

other txs for acute urticaria

A
  • stop the causative drug
  • start hypoallergenic products
  • prednisone taper if severe
  • ice, cool baths
  • refer to allergy
  • epinephrine for anaphylaxis
33
Q

oral 2nd generation antihistamine options

A
  • cetirizine
  • loratidine
  • fexofenadine
  • desloratadine
  • levocetirizine
  • nightly Singular
34
Q

what to r/o in chronic urticaria

A

physical utricaria w/ challenge test

35
Q

Tx of chronic urticaria

A
  • antihistamines
  • doxepin
  • singular
  • hydroxychloroquine
  • prednisone
  • cyclosporine
  • cellcept
  • dapsone
  • xolair
36
Q

omalizumab (xolair)

A
  • monocolonal antibody directed against IgE w/ low toxicity - good for those resistant to antihistamines
  • new drug

Dermatology 2 (10 decks)

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