Week 3 - Acute Inflammatory Dermatoses Flashcards

0
Q

What is urticaria and what mediates it?

A
  • Hives, transient raised wheals that persist for 24 hours
  • IgE & Histamine mediated
  • Pruritic (need to ask patient for this info)
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1
Q
Acute Inflammatory Dermatoses - Where do they prominently effect?
1.Urticaria
2. Erythema Multiforme
3. SJS/TEN
4. Fixed Drug Eruption
5. Panniculitis
Erythema Nodosum
Erythema Induratum
A
  1. Dermis
  2. Epi/dermis
  3. Epi/dermis
  4. Epidermis
  5. Subcut.
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2
Q

What is angioedema and why is it dangerous?

A
  • It is deep dermal and subcutaneous swelling
  • Burning & painful
  • Dangerous: Laryngeal Involvement - swelling of tounge, larynx after swelling of mouth and/or eyes
  • Epi is used for these reactions
  • Lips, eyes, groin, soles/palms are most common
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3
Q

What is acute urticaria?

A

It occurs in 2/3 of people and lasts less than 6 weeks. Its usually type I IgE mediated and resolves within hours-days

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4
Q

What are different types of Uritcaria?

A
  • Type I IgE mediated (food, latex, stings, medications, aeroallergins)
  • Autoimmune
  • Infectious - viral - HIV, hep C
  • Physical (solar, cholinergic, cold, dermographism-scratching skin, aquagenic, pressure)
  • Direct mast cell degranulation (medications)
  • Foods high in histamine
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5
Q

Urticaria Management: What medications are our first and second choices? What do we use for Type I IgE mediated reactions?

A

First choice: 2nd generation, non-sedating H1-blockers
-Cetrizine (Zyrtec)
-Fexofenadine (Allegra-D)
-Desloratadine (Clarinex)
-Loratidine (Claritin)
Second choice: If symptoms not controlled, add second generation, sedating H1 blockers
-Hydroxyzine (Atarax) at night
-Diphenhydramine (Benadryl) at night
Cyproheptadne (Periactin) -Cholinergic and cold urticarial
-EpiPen!

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6
Q

What is erythema multiforme?

A
  • Usually associated with prescription medications
  • Circular lesions on palms, soles of feet, multiple confluent lesions (coming together), raised, erythematous, bilateral (both hands)
  • Classic ‘target’ lesions with multiple spots, inflammatory middle-soft, uneven boarder
  • Usually occurs in people under 20
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7
Q

What typically causes erythema multiforme?

A

Drugs - sulfonamides, penicillin, barbiturates, etc.
Infection - herpes simplex virus, mycoplasma
Many cases are idopathic

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8
Q

How to treat EM?

A

Prevent, Supportive therapy, use medication to control herpes simplex, Glucocorticoids like prednisone to treat severe cases

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9
Q

What is the difference between SJS and TEN?

A

SJS - <10% dermal attachment
TEM - 30% dermal attachment
They overlap in the 10-30% range

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10
Q

What is SJS?

A
  • Drug induced or idiopathic
  • Skin tenderness and erythema (skin & mucosa)
  • Cutaneous & Mucosa Epiderma Necrosis & Sloughing
  • Potentially life threatening
  • +2 mucosal membranes effected and <10% epidermal detachment
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11
Q

What is the proposed mech. for SJS and TEN?

A

Cytotoxic immune reaction aimed at destruction of keratinocytes expressing foreign (drug-related) antigens

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12
Q

What is toxic epidermal necrolysis? (TEN)

A
  • Maximal variant of SJS with 30% epidermal detachment
  • Severe hypersensitivity syndrome - life threatening
  • Total detatchment of epidermis (like total body second degree burn)
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13
Q

What are fixed drug eruptions?

A
  • Epidermal
  • Usually face & genitals
  • Unknown mech
  • Can reoccur in same place
  • Localized, sharply demarcated erythematous patch that can itch, burn or be asymptomatic
  • Caused by a drug
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14
Q

What are the two types of Panniculitis?

A
  1. Erythema Nodosum

2. Erythema Induratum

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15
Q

What is Erythema Nodosum?

A
  • Painful, tender nodules, with fever, malaise, arthralgia (ankles)
  • Resolves on own in 6 wks
  • Erythematous tender nodules, anterior shins, no ulceration
  • usually occurs in young women
  • Can be triggered by infection, meds or autoimmune
16
Q

What is Erythema Induratum?

A
  • Tender, red nodules, often associated with TB
  • Occurs in middle aged females most
  • most often posterior legs
  • Chronic, subcutaneous plaques & nodules with ulceration
  • Immune complex mediated