Week 3 - Acute Inflammatory Dermatoses Flashcards Preview

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Flashcards in Week 3 - Acute Inflammatory Dermatoses Deck (17):
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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

1. Dermis
2. Epi/dermis
3. Epi/dermis
4. Epidermis
5. Subcut.

1

What is urticaria and what mediates it?

-Hives, transient raised wheals that persist for 24 hours
-IgE & Histamine mediated
-Pruritic (need to ask patient for this info)

2

What is angioedema and why is it dangerous?

-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

3

What is acute urticaria?

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

4

What are different types of Uritcaria?

-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

5

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

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!

6

What is erythema multiforme?

-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

7

What typically causes erythema multiforme?

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

8

How to treat EM?

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

9

What is the difference between SJS and TEN?

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

10

What is SJS?

-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

11

What is the proposed mech. for SJS and TEN?

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

12

What is toxic epidermal necrolysis? (TEN)

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

13

What are fixed drug eruptions?

-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

14

What are the two types of Panniculitis?

1. Erythema Nodosum
2. Erythema Induratum

15

What is Erythema Nodosum?

-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

What is Erythema Induratum?

-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