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CMT > Reactive Erythemas > Flashcards

Reactive Erythemas Flashcards

1
Q

Urticaria

cell of origin

A

mast cell

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2
Q

Urticaria

what do mast cells release to cause the rxn?

A

histamine

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3
Q

Urticaria

what type of hypersensitivity rxn is this?

A

type 1

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4
Q

Urticaria

describe the condition

A
  • vascular rxn of the upper epidermis characterized by wheals surrounded by an erythematous halo
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5
Q

Urticaria

common causes

7

A
  1. idiopathic
  2. infection
  3. food rxn
  4. drug rxn
  5. IV admin of blood products/contrast dye
  6. physical causes (pressure, cold/heat, water, sunlight, exercise, emotion)
  7. autoimmune
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6
Q

Urticaria

Clinical Manifestations

A
  1. ITCH
  2. lesions appear over the course of minutes, enlarge, and then disappear (within 12 hrs)
  3. blanch w/ pressure
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7
Q

Urticaria

tx

A

First Line: 1st gen antihistamines

in real life, 2nd gen antihistamines more commonly used

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8
Q

Urticaria

considerations when prescribing 1st gen antihistamines

A
  • cause sedation & require dosage adjustment in children, elderly, renal, hepatic impairement, resp disease, BPH, glaucoma
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9
Q

Angioedema

what type of hypersensitivity rxn causes this?

A

Type 1 rxn

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10
Q

Angioedema

located where compared to the urticaria?

A
  • deep dermis and subcutaneous tissue
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11
Q

Angioedema

check for what type of med use?

A

ACE inhibitors

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12
Q

Angioedema

clinical manifestations

4 components

A
  • trademark swelling: most commonly affects the face (lips, cheeks, periorbital areas) or portion of extremity
  • concerning if the tongue, pharynx, larynx, and bowels are affected
  • may be painful or burning (not pruritic)
  • can last several days
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13
Q

Angioedema

Tx

A
  1. IV or oral glucocorticoids + 1st gen antihistamines
  2. Epinephrine if severe
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14
Q

Stevens-Johnson Syndrome

AKA

A

Toxic Epidermal Necrolysis

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15
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

what is associated w/ poor prognosis?

A
  1. increasing age
  2. comorbidities
  3. greater extent of skin involvement
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16
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Assoicated w/ which meds

A
  • sulfa drugs
  • allopurinol
  • tetracyclines
  • anticonvulsants
  • NSAIDS
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17
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

If med induced, when will sx appear?

A

within the first 8 wks after drug initiation

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18
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Clinical Manifestations

A
  1. eruption is symmetric
  2. pain is prominent
  3. epidermis easily detaches at pressure points
  4. mucous membrane involvement
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19
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

where does eruption of rash typically begin? does it spread? where?

A

begin on the face, upper trunk, and proximal extremities then spreads to rest of the body.

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20
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

what does pain in lesions signify?

A

necrosis

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21
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

describe initial lesions

A
  • erythematous, irregularly shaped, dusky red to pruritic macules
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22
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

what do lesions evolve to?

A
  • progressively coalesce
  • evolve to flaccid blisters, which spread w/ pressure & break easily
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23
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

when the epidermis is peeled back, what is exposed?

A
  • erythematous, oozing dermis
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24
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

classifications by BSA

SJS vs SJS/TEN vs TEN

A
  • SJS: < 10%
  • SJS/TEN: 10-30%
  • TEN: > 30%
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25
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Tx

A
  • admission to burn unit
  • stop offending medication
  • IV corticosteroids, IV IG, cyclorsporine, enteraceept
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26
Q

Erythema Multiforme

what type of hypersensitivity is this?

A

Type 4

27
Q

Erythema Multiforme

appears after what types of exposures?

2

A
  • infectious
  • medication
28
Q

Erythema Multiforme

risk factors

5

A
  1. infections (HSV, mycoplasma, S. pneumoniae)
  2. meds (sulfa, beta-lactams, phenytoin, phenobarbital, allopurinol)
  3. malignancies
  4. autoimmune
  5. idiopathic
29
Q

Erythema Multiforme

Clinical Manifestations

A
  1. target lesions
  2. negative nikolsky sign
30
Q

Erythema Multiforme

describe the 3 components of a target lesion

A
  1. dusky, central area or bulla
  2. dark red inflammatory zone surrounded by pale ring of edema
  3. erythematous halo on periphery
31
Q

Erythema Multiforme

differentiate minor vs major condition

A
  • minor: target lesions distributed on extremities w/ no mucosal membrane involvement
  • major: target lesions on extremities w/ central progression w/ musosal membrane involvement (no epidermal detachment)
32
Q

Erythema Multiforme

tx

A
  • remove offending drugs, topical steroids, antihistamines, analgesics
  • systemic corticosteriods if severe
  • abx if mycoplasma is cause
33
Q

Brown Recluse Spider Bite

common where?

A

midwest & southwest

34
Q

Brown Recluse Spider Bite

what does the spider look like?

A

violin pattern on its cephalothorax

35
Q

Brown Recluse Spider Bite

clinical manifestations

A
  1. burning sensation
  2. erythema at the bite site
  3. potential skin necrosis
  4. general sx: fever, chills, n/v, mobilliform rash
36
Q

Brown Recluse Spider Bite

the venom is ____ and _____

A
  • cytotoxic
  • hemolytic
37
Q

Brown Recluse Spider Bite

explain progression of bite site

A
  1. erythema for 3-4 hrs
  2. blanching of the area
  3. erythematous margin around ischemic center (red halo, 24-72 hrs)
  4. hemorrhagic bulla that undergoes eschar formation (sloughs off after)
38
Q

Brown Recluse Spider Bite

Tx

general pop

A
  • local wound care
  • pain control (NSAIDS)
  • tetanus vax if needed
39
Q

Brown Recluse Spider Bite

Tx

with necrosis

A
  • debridement once lesion is well demarcated
  • abx if secondary infection present
40
Q

Black Widow Spider Bite

what does spider look like

A

right hourglass shape on underside of belly

41
Q

Black Widow Spider Bite

clinical manifestations

A
  • localized pain at bite site
  • systemic & neurologic sx onset 30 min to 2 hrs after bite
42
Q

Black Widow Spider Bite

appearance of bite

A
  • blanched circular path
  • erythematous perimeter
  • central punctum
43
Q

Black Widow Spider Bite

what systemic & neurologic sx occur?

A
  • muscle pain (extremities, abdomen, back)
  • spasms and rigidity
44
Q

Black Widow Spider Bite

tx

A
  • usually self limited
  • wound care
  • pain/spasm control
  • anti-venom
  • tetanus vax
45
Q

Black Widow Spider Bite

when is anti-venom recommended?

A

refractory sx

46
Q

Black Widow Spider Bite

what to prescribe for muscle spasms?

A

muscle relaxants (benzodiazepines)

47
Q

Cellulitis

caused by what?

NOT THE CAUSATIVE ORGANISMS, ACTUALLY HOW

A

infection of the dermis that begins wi/ loss of integrity of the skin

48
Q

Cellulitis

caused by which bacterias?

A
  1. Group A Strep (80%)
  2. S. aureus
  3. MRSA
  4. Pasteurlla multiocida
49
Q

Cellulitis

risk factors

A
  • local trauma
  • spread of preceding or concurrent skin lesion
  • pre-existing skin infection
  • edema/impaired lymph
50
Q

Cellulitis

clinical manifestations

A
  • spreading erythematous, non-fluctuant, tender, poor defined plaque
  • occurs in lower extremities most often
51
Q

Cellulitis

what does tx course depend on?

A

purulent vs non-purulent

52
Q

Cellulitis

tx for non-purulent cellulitis

A
  • cephalexin
  • amoxicillin
  • augmentin (animal bites)
  • clindamycin
53
Q

Cellulitis

purulent cellulitis tx

A
  • clindamycin
  • TMP/SMX
  • doxycycline + amox
54
Q

Cellulitis

general care measures for lesion

A
  • elevate
  • cool compress
55
Q

Erysipelas

most often caused by?

top 3 bacteria

A
  1. Group A Strep
  2. S. aureus
  3. Haemophilus
56
Q

Erysipelas

what is it?

A

superficial cellulitis w/ marked dermal lymphatic involvement (causes edema)

57
Q

Erysipelas

clinical manifestations

A
  • typically on face/lower extremities
  • painful, bright red erythematous, plaque like edema w/ sharp margins
  • may develop bullae
  • can be associated w/ high WBC count
  • fever ,chills, headache, vomiting, joint pain
58
Q

Erysipelas

tx

A
  1. empiric abx therapy
  2. elevation of area
  3. close monitoring
59
Q

Erysipelas

what abx used?

A
  1. PCN V
  2. amox
  3. clinda
  4. azithro
60
Q

Lymphangitis

what is it?

A

inflammation of lymphatic channels due to infectious/non-infectious causes

61
Q

Lymphangitis

clinical manifestations

A
  • red, tender streaks extending proximally from a site of cellulitis
  • may have lymphadenopathy or systemic sx (fever/chills)
62
Q

Lymphangitis

Tx

A
  • Oral: cephalexin, dicloxacillin (macrolide if PCN allergy)
  • IV: cefazolin, augmentin, ceftriaxone + clindamycin
63
Q

Lymphangitis

Tx if MRSA

A
  • Oral: TMP-SMZ + cephalexin
  • IV: vancomycin

CMT (72 decks)

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